Geetha Kuppani
ISELIN,NJ
Summary
Inpatient Coder with extensive expertise in medical coding and compliance. Known for accuracy and adaptability in high-pressure environments. Achievements include streamlining coding processes and ensuring data integrity. Proven ability to enhance revenue recovery through detailed auditing and error correction.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Managed Care Appeals Analyst
ELevate PFS holdings
Remote
12.2024 - Current
- Actively monitored progress on pending appeal cases ensuring timely completion of tasks associated with each claim dispute resolution.
- Compiled data for appeals cases utilizing Microsoft Office Suite products.
- Attended meetings with management staff concerning policy changes impacting the appeals process.
- Conducted research on evidence submitted in support of appeals.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Managed denials, late payments, extensions and other special circumstances by following up with relevant parties.
Medical Coder
14 Street Medical PC
New York, NY
09.2022 - 12.2024
- Successfully increased coding accuracy rate to 98% by implementing new quality control measures and conducting regular audits, resulting in improved claim reimbursement rates for the company.
- Streamlined the coding process by developing and integrating a comprehensive coding guideline system, reducing coding time by 20%, and increasing overall productivity.
- Trained and mentored a team of 10 new medical coders, leading to a 100% pass rate on their certification exams, and contributing to the expansion of The Coding Network’s workforce.
- Identified and resolved over 500 coding discrepancies in a single month, preventing potential claim denials and saving the company an estimated $100,000 in lost revenue.
- Conducted a comprehensive audit of past medical claims, identifying and correcting over $150,000 worth of under-coded and over-coded claims, ensuring accurate reimbursement and compliance with industry regulations.
- Specialties: Cardiology, Radiology, General medicine, Orthopedic, Pain management, Physical Therapy, Podiatry, Inpatient coding, Neurology
Accountants Receivable
Frontage Laboratories
05.2022 - 09.2022
- Processing invoices for accounts receivable and accounts payable.
- Monthly reconciliations for each project of clinical trials.
- Monthly revenue recognition.
- Processing sponsors requests in terms of billing inquiries.
- Processing contracts received from the sponsors and issuing invoices to sponsors as per contract.
- Processing quality check for clinical trial documents, protocols, clinical study reports, case reports.
- Posting payments.
- Budget reconciliations for projects.
- Monitored cash flows and prepared weekly cash projections.
- Coordinated with external auditors during the annual audit process by providing requested documents and responding to inquiries in a timely manner.
Medical Coder
Aergo Solutions
Iselin, NJ
09.2021 - 05.2022
- Hospital coding and billing.
- DRG validation of records.
- Accounts receivable for the records.
- Validation medical records for claims processing.
- Auditing of medical records prior to billing.
- Develop provider specific performance report cards.
- Provide analytical support of provider performance under value based contracts.
- Develop reports and analyze data to measure clinical outcomes, network performance and methodology levers.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Performed audits on coded claims to ensure that all required data elements are included for accurate payment processing.
- Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
- Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
- Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Participated in coding team meetings to discuss challenges and best practices.
- Conducted audits to ensure compliance with federal and state regulations.
- Reviewed patient records and assigned accurate codes for diagnoses and procedures.
Denial Specialist
Digital Medical billing
11.2020 - 09.2021
- Accounts Manager for orthopedic account.
- Accurately assigned ICD and CPT codes to patient medical records.
- Reviewed patient charts and identified discrepancies in the medical documentation.
- Interpreted medical terminology in order to translate it into coding.
- Communicated with insurance companies regarding the updates in invoices.
- Worked on patient record audits and documentation quality checks.
- Key Achievement: Maintained 97% accuracy per150 daily claims when assigning ICD and CPT codes to patient records.
- Analyzed and interpreted policy language, medical records, and other relevant data to identify coverage issues.
- Resolved billing disputes between providers and third party payers in a timely manner.
Medical Coding and Billing Specialist
Advanced pain care
Maplewood, NJ
08.2020 - 11.2020
- Assigning CPT codes for pain care management medical records.
- Accounts receivable.
- Pain care billing.
- Researched denied claims to determine the cause of denial and corrected errors as needed.
- Developed policies and procedures related to medical coding processes.
- Generated reports from software systems to track claim status and denials.
- Submitted claims electronically to insurance companies in accordance with regulations.
- Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
- Facilitated payment arrangements with patients and guarantors who were unable to make full payment at time of service.
- Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
Physical Therapy Coder
Americare physical therapy
Mountainside, NJ
09.2019 - 03.2020
- Physical coding and billing.
- Payment posting.
- Homecare billing.
- Insurance verification.
- Conducted code reviews to ensure adherence to coding standards and best practices.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Entered charge rationale in patient account notes.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Education
Master of Science - Clinical Biochemistry
Sri Sankara College of Arts And Science
Enathur, Kanchipuram, India01.2006
Bachelor of Science - Clinical Biochemistry
Jaya College of Arts And Science
Chennai01.2004
Skills
- ICD-10
- CPT
- HCPCS
- EHR proficiency
- HIPAA compliance
- Medical terminology
- Anatomy knowledge
- Appeals management
- Claims analysis
- Billing dispute resolution
- Problem solving
- Attention to detail
- Time management
- Investigate claims
- Inpatient coding
- DRG validation
- Reimbursement analysis
- Medical record auditing
Certification
CPC certified in medical coding (CPC).
Course Work
- Medical terminology
- DRG validation
- Inpatient coding
- Anatomy & Physiology for coders
- Introduction to coding
- Diagnostic Coding
- Coding Compliances & ethics
- Healthcare common Procedures
Timeline
Managed Care Appeals Analyst
ELevate PFS holdings
12.2024 - Current
Medical Coder
14 Street Medical PC
09.2022 - 12.2024
Accountants Receivable
Frontage Laboratories
05.2022 - 09.2022
Medical Coder
Aergo Solutions
09.2021 - 05.2022
Denial Specialist
Digital Medical billing
11.2020 - 09.2021
Medical Coding and Billing Specialist
Advanced pain care
08.2020 - 11.2020
Physical Therapy Coder
Americare physical therapy
09.2019 - 03.2020
Master of Science - Clinical Biochemistry
Sri Sankara College of Arts And Science
Bachelor of Science - Clinical Biochemistry
Jaya College of Arts And Science
Similar Profiles
Shobhna KumarShobhna Kumar
A/R Follow Up Specialist at Elevate PFS Holdings, INCA/R Follow Up Specialist at Elevate PFS Holdings, INC
Jailene TaverasJailene Taveras
Bilingual Patient Advocate at Elevate PFS HoldingsBilingual Patient Advocate at Elevate PFS Holdings
Ernestine MabreyErnestine Mabrey
Patient Advocate at Elevate PFSPatient Advocate at Elevate PFS
Mubeen ButtMubeen Butt
Business Intelligence Analyst at General Vision ServicesBusiness Intelligence Analyst at General Vision Services
Joseph KopchikJoseph Kopchik
Branch Ambassador at Capital OneBranch Ambassador at Capital One