Prabhalakshmi Raman Krishnan
Edison,NJ
Summary
Hardworking and detail-oriented professional with extensive field experience, known for consistently delivering high-quality work and exceeding expectations. Proven track record of success, reliability, and a proactive mindset. Skilled in verifying documentation to prevent errors and minimize rework, while continuously seeking opportunities to improve processes and workflows. Excels at multitasking in fast-paced environments, maintaining a conscientious work ethic, and driving successful outcomes.
Overview
13
13
years of professional experience
Work History
Freelancing Medical Record Reviewer
- Personal Injury Attorney
Nevada City, NV
02.2016 - Current
- Reviewed and evaluated medical records for accuracy, completeness, and compliance with regulatory requirements.
- Conducted reviews of patient care documents to ensure appropriate coding practices are in place.
- Assessed medical information to identify the appropriateness of services rendered and determine if claims were medically necessary.
- Performed retrospective reviews of medical records, insurance policies, and other relevant documentation.
- Analyzed data from various sources such as clinical guidelines, research studies, and government regulations.
- Identified potential discrepancies between submitted claims and supporting documentation.
- Developed detailed reports on findings based on review results.
- Communicated with providers regarding issues identified during the review process.
- Tracked all activities related to medical reviews in database systems.
- Coordinated with internal departments to resolve any discrepancies found during reviews.
- Assisted in training new employees on procedures for completing medical reviews.
- Prepared presentations summarizing findings from completed reviews for the management team.
- Reviewed billing codes assigned by providers for accuracy prior to processing payment claims.
- Monitored the progress of ongoing projects related to medical review processes.
- Assessed contracts and medical information to make eligibility determinations.
- Maintained a positive working relationship with fellow staff and management.
- Handled incoming calls and directed callers to the appropriate department or employee.
- Safeguarded medical records to maintain patient confidentiality.
- Entered patient insurance, demographic, and health information into software and confirmed records.
- Proofread documents carefully to check the accuracy and completeness of all paperwork.
- Set up patient charts and documented information in various company software.
- Transmitted information or documents to customers through email, mailings, or facsimile machine.
- Streamlined day-to-day office processes to meet long-term goals.
Medical Record Reviewer
Trivent Systems Private
Chennai, India
10.2014 - 01.2016
- Reviewed medical records to ensure the accuracy and completeness of patient data.
- Analyzed medical documents for discrepancies and missing information.
- Maintained accurate documentation of all review activities.
- Performed data entry into electronic health record systems.
- Assisted in the development of new procedures for medical record review processes.
- Collaborated with other departments to ensure proper coding and billing practices were followed.
- Ensured compliance with HIPAA regulations regarding patient privacy, security, and confidentiality of healthcare information.
Team Lead Medical Record Reviewer
ENoah ISolution
Coimbatore, India
03.2012 - 08.2014
- Provided leadership and guidance to team members, ensuring tasks were completed on time, and to a high standard.
- Conducted performance appraisals for team members, providing feedback and identifying areas of improvement.
- Trained new staff in relevant processes and procedures.
- Resolved escalated customer complaints or queries promptly and efficiently.
- Ensured compliance with company policies and procedures throughout the team.
- Monitored team performance against targets, taking corrective action where necessary.
- Supported the manager in developing plans for future projects, initiatives, and objectives.
- Coordinated resources across multiple teams to achieve project goals within budget constraints.
- Identified opportunities for process improvements, implementing changes when required.
- Motivated staff through positive reinforcement techniques.
- Delegated tasks appropriately according to individual skill sets.
Education
Bachelor of Science - Nursing
Sri Ramakrishna Institute of Paramedical Sciences
India07-2012
Skills
- Accuracy and attention to detail
- Documentation verification and error prevention
- Process improvement
- Workflow optimization
- Leadership and guidance
- Training and development
- Customer complaint resolution
- Team performance monitoring
- Policy and procedure compliance
- Task prioritization
- Problem-solving
- Market research
- Client communication
- Project management
- Multitasking and organization
- Critical thinking
Timeline
Freelancing Medical Record Reviewer
- Personal Injury Attorney
02.2016 - Current
Medical Record Reviewer
Trivent Systems Private
10.2014 - 01.2016
Team Lead Medical Record Reviewer
ENoah ISolution
03.2012 - 08.2014
Bachelor of Science - Nursing
Sri Ramakrishna Institute of Paramedical Sciences
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