ESWARI RAJ

• Assign ICD10, Infusion CPT, HCPCS, Modifiers to both infusion and in office E/M services.
• Proficient with pharmacy Nucleus reports, SDV/MDV modifier, government and commercial payer policy guideline for HCPCS coding and documentation requirements for infusion billing.
• Demonstrate analytical and problem-solving skills
• Ability to resolve barriers in receiving valid and accurate ICD 10, CPT, HCPCS injection codes
• Expertise understanding of Infusion drug policy and procedure for Chemo IV drugs
• Utilizes complete medical record documentation in codes assignment, validation and or editing of codes
• Proactively guide clinicians, Pharmacists on drug policy guidelines/ changes to policies and procedures.
• Research on denials and retrospectively query physician and clinicians for medical necessity to resolve denials
• Follows all applicable coding guidance in assigning, sequencing, Modifiers and adherence to compliance guidelines as appropriate by company policies and procedures
• Meets all educational requirements as stated in current company policy
• Keep up to-date knowledge of Medicare guidelines for infusion coding, Medicare quarterly drug policy guidelines.

• Analyzed progress notes, op reports, pathology reports, patient insurance information, and various other health information documents for coding

• Reviewed documentation available in Medical Record to facilitate workflows that support clinical picture/severity of illness/complexity of patient care rendered to patients
• Utilized available encoder, grouper software, and other coding resources to determine appropriate ICD-10-CM diagnosis codes mapped to HCCs
• Actively participated in and maintain coding quality and productivity processes
• Collaborated with nursing or coding staff on retrospective medical record review for severity, accuracy, and quality issues
• Provided ongoing feedback to physicians and other providers regarding coding guidelines and requirements
• Participated in training new coding staff, as needed
• Improved overall productivity by streamlining coding process through efficient organization and time management.
• Enhanced coding accuracy by consistently reviewing and updating knowledge of HCC guidelines and regulations.
• Participated in industry networking events and organizations, fostering relationships with fellow professionals and staying informed about upcoming changes or trends in HCC coding practices.
• Served as an integral team member in departmental meetings, contributing insights based on expertise in HCC coder''s perspective toward improving operational efficiency or addressing challenges faced within the unit.
• Provided mentorship and guidance to junior coders entering the field, sharing expertise on best practices for accurate and efficient coding assignments.
• Provided expert consultation on complex cases that required specialized knowledge of HCC coding rules and guidelines, offering guidance for optimal code assignment strategies.
• Managed a high volume of medical records efficiently while maintaining exceptional attention to detail during the coding process.
• Stayed current with evolving industry standards, attending professional development seminars and workshops related to HCC coding advancements.
• Together with manager provided assistance in developing SOP's for certain payor requirements of AHA billing.

Coded Outpatient surgery / diagnostic procedures

-Ophthalmology office and outpatient surgical procedures- VF test, refraction, cataract, strabismus, cornea transplantation, Trab, Glaucoma, Keratoplasty, Oculoplastic, Tear duct, PRP laser, YAG laser

-Neurology diagnostic procedures EEG, EMG, Nerve conduction study, Myelography

-Pulmonary Diagnostic Tests & Procedures Bronchoscopy, Thoracentesis, Lung bx, PFT'S, EBUS, EBV.

• Coding support for a team of 8 surgical and non surgical coders/billing.
• Conducts monthly audits for the team
• Coding and denial management for Colorectal General Surgery, Ortho OP , Plastics, Neuro, SDS, IR cath procedure, Allergy Injection.
• Managed and resolved claim edit errors
• Experience with EDI file reconciliation
• Actively participated in inter-department financial, clinical, budget meetings and communicate to team based on need
• Provided coding payor policy updates to the tea.
• Acted as liaison between providers, coders & financial department to enhance the workflow in EPIC and charge capture.
• Analyzed provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code
• Experienced in all aspects of RCM

• Audited clinical info, diagnosis, ICD & eligibility for home care intake
• Coordinated clinical information, lab orders & results through the hospital systems, communicated with appropriate clinic/Dr office for further Physician orders
• Maintained records on third party documentation and billing regulations
• Maintained, audited, organized electronic/physical medical record
• Assisted with Customer support, Patient calls, Scheduling, Registration
• Running open claims and working monthly Accounts Receivables –A/R reports Data Entry/Patient demographics (updating /deleting / correcting / insurance info) Worked electronic claim rejections / resubmit electronically

• Managed multi-specialty billing office which included 30+ physicians of all specialties (pediatrician, family practice, endocrinology, Respiratory care, Allery & Immunology, plastic surgery, general surgery, Ophthalmology)
• Increased revenue by 25% for Surgery & Ophthalmology through optimized coding and prompt billing
• Reduced 2 years backlog to 120 days revenue cycle
• Handled complex denials and appeals to institute settlement
• Played key role in new billing software implementation and development projects.
• Enhanced client satisfaction with timely communication, clear explanations of claim outcomes.