PAGADALA VUEHITHA PERSIS
St. Louis
Summary
Certified Professional Coder with 4 years of expertise in medical coding, emphasizing compliance and precision. Proficient in advanced coding software and medical terminology, enhancing billing accuracy and regulatory adherence. Committed to leveraging problem-solving skills and attention to detail for optimizing healthcare processes and outcomes.
Efficient professional in healthcare documentation boasts high productivity and the capability to complete tasks swiftly while maintaining accuracy. Skilled in medical coding, electronic health records management, and data analysis. Excel in organizational, communication, and problem-solving skills, ensuring seamless workflow and compliance with healthcare regulations.
Overview
4
4
years of professional experience
1
1
Certification
Work History
SENIOR MEDICAL CODER
Omega Healthcare and Management Services
03.2022 - 08.2022
- Utilized advanced coding knowledge to support high-priority projects, including the Cigna Project, focusing on coding accuracy and compliance for specialty claims, and the Aetna Project, optimizing documentation for seamless claims processing and reimbursement.
- Conducted quality assurance audits and compliance checks to ensure coding aligned with CMS standards, payer-specific guidelines, and organizational policies, minimizing errors and reducing claim rejections.
- Provided leadership to a team of medical coders, mentoring and training them to ensure accurate application of ICD-10, CPT, and HCPCS Level II codes for inpatient and outpatient records, while adhering to CMS guidelines and HIPAA regulations.
- Monitored and enforced HIPAA compliance across all coding processes, safeguarding patient confidentiality while maintaining regulatory standards.
- Resolved coding-related denials for high-value claims, contributing to improved revenue cycle management and maximizing reimbursement for both Cigna and Aetna projects.
- Prepared detailed performance reports for leadership, highlighting project outcomes, team metrics, and opportunities for process improvements across multiple payer projects.
ASSOCIATE MEDICAL CODER
Optum Global Solutions
06.2019 - 03.2022
- Accurately assigned ICD-10, CPT, and HCPCS Level II codes to both outpatient and inpatient medical records, ensuring proper documentation for billing and reimbursement.
- Conducted regular coding audits to ensure compliance with CMS and insurance guidelines, improving overall accuracy in time.
- Collaborated with physicians and healthcare providers to clarify documentation and resolve coding-related queries.
- Assisted in resolving coding denials and issues, contributing to more efficient reimbursement processes.
- Participated in ongoing training sessions to stay current on industry updates and coding changes.
- Contributed to enhanced coding accuracy and efficiency within the organization by supporting process improvements.
- Gained practical experience coding a variety of medical records under the guidance of experienced coders.
- Supported coding audits and compliance reviews to ensure adherence to regulatory standards.
- Developed strong proficiency in medical coding software and EHR systems, facilitating efficient coding workflows.
- Working knowledge MS-DRG in IP settings.
- Engaged in educational seminars and workshops to further enhance coding skills and stay informed of industry advancements.
- Served as a Subject Matter Expert (SME) for coding teams, providing advanced guidance on ICD-10, CPT, and HCPCS Level II coding, and ensuring adherence to CMS guidelines, payer-specific requirements, and HIPAA regulations.
- Prepared detailed performance reports for leadership, highlighting project outcomes, team metrics, and opportunities for process improvements across multiple payer projects.
- Complied and presented performance reports to the manager, emphasizing team metrics and project outcomes.
ASSOCIATE MEDICAL CODER
Wipro Private Limited
09.2018 - 06.2019
- Assigned ICD-10, CPT, and HCPCS codes for outpatient and inpatient services, ensuring accuracy in coding diagnoses, procedures, and services.
- Contributed to the Change Healthcare Project, supporting accurate coding and documentation for high-volume claims, improving processing efficiency and data quality.
- Actively learned and applied Evaluation and Management (E/M) and Emergency Department (ED) coding guidelines, ensuring accurate assignment of codes based on patient encounters and documentation.
- Applied the correct modifiers to CPT and HCPCS codes, ensuring that modifiers accurately reflected the services provided, supported claims processing, and complied with payer policies.
- Followed CMS, HIPAA, and payer-specific guidelines, ensuring all coding was compliant with regulations and aligned with reimbursement criteria.
- Collaborated with senior coders and healthcare providers to identify and address gaps in documentation, ensuring the codes assigned matched the documented medical services.
- Assisted with internal audits, ensuring coding accuracy and compliance, and addressing any issues or discrepancies found during audits.
- Worked effectively with senior coders and other team members during the Change Healthcare Project, supporting process improvements and ensuring accurate, timely coding.
Education
MASTER'S - INFORMATION TECHNOLOGY MANAGEMENT
Webster University
St. Louis10.2024
BACHELOR'S - PHARMACY
Kottam Institute of Pharmacy
06.2018
Skills
- Medical Terminology
- MRM
- Microsoft PowerPoint, Word and Excel
- Regulatory compliance
- Revenue cycle management
- Documentation improvement
- Data analysis
- Process improvement
- Team collaboration
- Clinical documentation improvement
- Strong attention to detail
- Outpatient coding
- Medicare and medicaid regulations
- Decision-making capacity
- HIPAA compliance
- Coding Error Resolution
- Patient Data Identification
- Effective communication
- Patient data identification
- Data entry
- Ethical standards
- Data verification
Certification
CERTIFIED PROFESSIONAL CODER (CPC) CERTIFICATION, AAPC (American Association of Professional Coders), 09/19
Timeline
SENIOR MEDICAL CODER
Omega Healthcare and Management Services
03.2022 - 08.2022
ASSOCIATE MEDICAL CODER
Optum Global Solutions
06.2019 - 03.2022
ASSOCIATE MEDICAL CODER
Wipro Private Limited
09.2018 - 06.2019
MASTER'S - INFORMATION TECHNOLOGY MANAGEMENT
Webster University
BACHELOR'S - PHARMACY
Kottam Institute of Pharmacy