Lalitha S
Summary
Certified Coding Specialist (CCS) with 5+ years of experience in payer-aligned medical coding, clinical documentation review, and DRG validation across inpatient and outpatient healthcare settings. Demonstrated expertise in ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding methodologies, CMS regulatory compliance, Medicaid policy requirements, and claims processing systems. Conducted coding impact analysis for CMS coding updates, validated medical necessity, and supported accurate implementation of coding business rules within healthcare and payer systems. Reviewed complex medical records to ensure coding accuracy, reimbursement integrity, and compliance with CMS, Medicaid, and payer guidelines. Collaborated with clinical, operational, and technical teams to improve coding compliance, claims adjudication accuracy, and revenue integrity. Utilized Optum Encoder, Epic, and EHR systems to perform coding validation, audit analysis, and compliance monitoring.
Overview
7
7
years of professional experience
Work History
Medical Coding Analyst
Randolph County Caring Community Partnership
Missouri City, MO
08.2024 - Current
- Performed inpatient and outpatient coding using ICD-10-CM, ICD-10-PCS, CPT, and HCPCS in compliance
with CMS, Medicare, Medicaid, and payer guidelines. - Conducted coding audits, DRG validation, and clinical documentation review to ensure accurate claims
processing and reimbursement. - Reviewed clinical documentation to determine medical necessity and validate appropriate code assignment. •
Identified documentation gaps, coding discrepancies, and compliance risks affecting claims adjudication and
reimbursement. - Applied MS-DRG grouping logic, MCC/CC capture, and POA indicators to ensure compliant reimbursement
outcomes. - Supported coding quality assurance and compliance programs aligned with CMS coding standards and Medicaid
requirements. - Utilized Optum Encoder and EHR systems to perform coding abstraction, validation, and coding compliance
review. - Collaborated with internal teams to resolve coding issues and improve coding accuracy and claims processing
efficiency.
Medical Coder
Episource
Chennai, India
05.2019 - 12.2022
- Performed comprehensive coding validation and clinical record analysis using ICD-10-CM, CPT, and HCPCS in
compliance with CMS, Medicaid, and payer-specific guidelines. - Conducted coding impact analysis for CMS annual and quarterly coding updates and identified potential effects
on reimbursement and claims adjudication workflows. - Reviewed complex patient medical records to validate diagnosis and procedure coding, medical necessity, and
documentation compliance. - Evaluated coding compliance with CMS regulations, Medicaid policy requirements, and payer claims
processing. - Supported implementation and validation of coding-related business rules within claims processing and
healthcare systems. - Collaborated with healthcare stakeholders and technical teams to resolve coding discrepancies and ensure
accurate claims processing. - Identified coding errors, documentation deficiencies, and compliance risks impacting claims adjudication and
reimbursement. - Utilized Optum Encoder, Epic, and EHR systems to perform coding abstraction, validation, and compliance
review. - Maintained coding documentation, audit findings, and coding reference materials aligned with CMS and
Medicaid regulatory requirements. - Assisted in ensuring coding accuracy and compliance with CMS, Medicaid, and payer claims processing
systems
Education
Master of Science - Health Informatics
Indiana University - Purdue University Indianapolis
Indianapolis, IN12.2024
Bachelor of Pharmacy -
Vijaya Institute of Pharmaceutical Sciences
India07.2019
Skills
- Medical Coding & Classification Systems: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, MS-DRG assignment, DRG validation, MCC/CC capture, POA indicators, coding compliance
- CMS, Medicaid & Regulatory Compliance: CMS annual and quarterly coding updates, Medicaid policy, Medicare guidelines, claims adjudication rules, medical necessity review, regulatory compliance
- Healthcare Domains: Medicaid, Medicare, inpatient coding, outpatient coding, acute care coding, revenue cycle management
- Payer & Claims Processing Systems: Payer-side coding, claims processing systems, reimbursement validation, claims lifecycle, coding impact analysis, business rule validation
- Healthcare Systems & Coding Tools: Optum Encoder, Encoder Pro, Epic, Cerner, EHR/EMR systems, DRG grouping tools
- Healthcare Data & Audit Analysis: Coding audits, DRG audits, coding quality assurance, compliance monitoring, audit reporting, revenue integrity analysis
- Healthcare IT & System Collaboration: Business rule analysis, requirements validation, collaboration with IT developers, system impact analysis, UAT support
- Clinical Documentation Review: Clinical documentation analysis, diagnosis validation, procedure validation, chart review, operative reports, discharge summaries, physician documentation review
Websites
Work Preference
Work Type
Full TimeLocation Preference
On-SiteRemoteHybridImportant To Me
Career advancementWork-life balanceCompany CultureFlexible work hoursTimeline
Medical Coding Analyst
Randolph County Caring Community Partnership
08.2024 - Current
Medical Coder
Episource
05.2019 - 12.2022
Master of Science - Health Informatics
Indiana University - Purdue University Indianapolis
Bachelor of Pharmacy -
Vijaya Institute of Pharmaceutical Sciences