Upendar Rapolu
Hyderabad
Summary
Total 7.5 years experienced in healthcare professional specializing in denial management and coding. Enhances coding accuracy and compliance while mentoring teams. Skilled in CPT/ICD-10 coding, fostering continuous improvement through effective communication and training initiatives. Delivers high-quality results in fast-paced environments.
Overview
8
8
years of professional experience
1
1
Certification
Work History
SME – Physician Coding & Denial Management
Primera Healthcare
Hyderabad
07.2024 - Current
- Managed multi-specialty denials and Physician Coding (E/M OP/IP, Wound Care).
- Identified root causes of denials and implemented targeted solutions to reduce recurrence.
- Ensured coding compliance (ICD-10, CPT, HCPCS).
- Identify the Reason for Denial - Review the Explanation of Benefits (EOB) to understand the denial reason.
- Prepared appeal documentation with supporting records.
- Submit Within Deadlines - Appeals must be filed within the payer's timeframe to be considered.
- Follow Up - Regularly check the status of the appeal and provide additional information if needed.
- Developed and updated educational materials for clinical staff and patients, enhancing understanding of coding compliance.
- Provided expertise in healthcare technology systems and implementation processes.
- Mentored junior staff, promoting continuous learning and improving team coding accuracy.
Senior Denial Coding Analyst
Sagility
Hyderabad
12.2022 - 07.2024
- Analyzed complex coding data to identify trends and discrepancies, improving overall coding accuracy.
- Collaborated with cross-functional teams to enhance coding accuracy and compliance, fostering a culture of quality assurance.
- Conducted audits on coding submissions to maintain quality standards.
- Reviewed medical records to ensure proper coding practices were followed.
- Developed training materials for new team members on coding guidelines, streamlining onboarding process.
Senior Denial Coding Analyst
Eclat Health Solution
Hyderabad
11.2021 - 12.2022
- Contributed to implementation of new coding policies across organization, enhancing compliance and standardization.
- Addressed coding inquiries from internal staff and clients, ensuring accurate and timely resolution.
- Managed multiple projects simultaneously while meeting tight deadlines without compromising quality or accuracy of deliverables.
- Updated knowledge of CPT and ICD-10 coding principles, government regulations, protocols, and third-party billing requirements to support effective coding practices.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
Medical Coder
Visionary RCM
Hyderabad
11.2018 - 11.2021
- Assigned appropriate codes using ICD-10 and CPT coding systems.
- Reviewed medical records for accurate coding and compliance with regulations.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Utilized electronic health record systems to track and manage coding tasks.
Education
B Pharmacy -
Nalanda college of pharmacy
01-2015
Skills
- Physician coding
- Denial Management & Resolution
- Denial management
- Revenue Cycle Management (RCM)
- Claim Rejections & Edits Resolution
- Medical coding
- Coding Audits & Quality Control
- Coding compliance
- Quality assurance
- Process analysis
- Healthcare software proficiency
- Microsoft Office Suite
- Training & Mentoring
- Communication and Active Listening
Certification
- CPC (AAPC)
Hobbies and Interests
- Playing Volleyball
- Playing Cricket
Disclaimer
I hereby declare that above mentioned information’s are correct to the best of my knowledge.
Languages
- Hindi
- Telugu
- English
- Hindi
- Telugu
Timeline
SME – Physician Coding & Denial Management
Primera Healthcare
07.2024 - Current
Senior Denial Coding Analyst
Sagility
12.2022 - 07.2024
Senior Denial Coding Analyst
Eclat Health Solution
11.2021 - 12.2022
Medical Coder
Visionary RCM
11.2018 - 11.2021
B Pharmacy -
Nalanda college of pharmacy