Priyanka Vadlamudi
Greenville
Summary
Profee Outpatient Surgery and HCC coding Specialist with over 5.9 years of experience in ICD-10-CM, CPT, HCPCS Level, and. Proficient in coding diverse procedures across specialties, including integumentary, musculoskeletal, urology, ophthalmology, gastrointestinal, ENT, breast, cardiac, neurosurgery, and nasal. Familiar with major insurers like Blue Cross Blue Shield, Aetna and Medicare, achieving above 90% accuracy in compliance and reimbursement. Certified Medical Coder with comprehensive knowledge in health information management and medical billing processes. Solid understanding of medical terminology, coding, ICD-10-CM, and CPT principles. Known for accuracy in data entry and ability to handle confidential patient information responsibly. Demonstrated success in streamlining operations for increased efficiency within previous healthcare settings.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Senior Medical Coder
Optum, UnitedHealth Group
03.2025 - Current
- Reviewing and coding medical records for Aetna Medicare members in compliance with CMS and ICD-10-CM guidelines.
- Assigned accurate Hierarchical Condition Category (HCC) codes to capture chronic conditions and ensure proper risk adjustment.
- Analyzed provider documentation to validate medical necessity and coding accuracy.
- Met or exceeded daily/weekly productivity and quality benchmarks for coding accuracy.
- Utilized EMRs for coding, data validation, and record retrieval.
- Collaborated with auditing teams to resolve coding discrepancies and improve accuracy rates.
- Maintained strict adherence to HIPAA guidelines and patient confidentiality.
- Contributed to improved RAF (Risk Adjustment Factor) scores through precise and compliant coding.
- Improved medical coding accuracy by conducting thorough reviews and implementing corrective actions.
Medical Coder - REMOTE
Vecode Healthcare LLC
06.2024 - 01.2025
- Worked in Elevance project handling charts with target processing rate of 95%
- Review, analyze, and code patient medical records based on client specific guidelines
- Follow ICD-10-CM Coding Guidelines and interpret coding guidelines for accurate code assignment
- Follow Risk Adjustment Data Abstraction Rules
- Expertise in HCC coding to ensure accurate risk adjustment and optimal reimbursement for patient care, improving overall financial outcomes
- Proficient in identifying and documenting chronic conditions to maximize appropriate HCC classifications and enhance compliance with regulatory guidelines
- Collaborated with clinical teams to review patient charts, ensuring accurate coding of diagnoses that align with HCC requirements
Senior Executive - Medical Coding Auditor
SCIOInspire Holdings, EXL group
11.2022 - 06.2023
- Conduct comprehensive reviews of medical records and coding documentation to ensure accuracy, completeness, and compliance with coding guidelines and regulatory requirements
- Assign accurate diagnostic and procedural codes to patient records using ICD-10-CM, CPT, and HCPCS coding systems
- Work closely with billing and reimbursement teams to resolve coding-related issues and optimize revenue cycle management
- Train and mentor junior coding staff on coding guidelines, regulations, and best practices
- Gained expertise in coding assignments primarily in Gastroenterology & Orthopedics
Senior Medical Coder
Omega Health Care Pvt. Ltd.
04.2021 - 10.2022
- Accurately reviewed and processed medical claims related to HCC coding, ensuring compliance with CMS (Centers for Medicare & Medicaid Services) guidelines.
- Conducted detailed audits of patient records, applying HCC coding principles to ensure proper diagnosis coding (ICD-10-CM) for risk adjustment purposes. Demonstrated expert knowledge in processing coding requirements with 96% accuracy on HCC projects.
- Utilized advanced billing software (e.g., Epic, 3M, Optum360) to submit claims and track payments, ensuring timely and accurate billing.
- Kept current with regulatory changes in HCC coding and billing procedures to maintain compliance with federal and state regulations.
- Provided support during audits, assisting with documentation requests, and ensuring that all claims were processed according to best practices.
- Driven the team’s coding performance with a targeted rate of over 95% accuracy within a short span of six months.
Junior Medical Coder
Avontix Global Solutions Pvt. Ltd.
01.2019 - 03.2021
- Underwent medical coding training from Transcode solutions
- Gained experience in same day surgery coding
- Assisted senior coders in conducting internal audits and reviewing accuracy
Education
Bachelor of Pharmacy -
Anurag Group of Institutions
Hyderabad, IN06.2018
Biology, Physics & Chemistry -
Sri Chaitanya Jr. College
Khammam, IN05.2012
Skills
- 3M
- Encoder Pro
- EPIC
- Citrix
- Optum 360
- Code Logix Plus
- HCC Coder
- Ability to multitask
- Work in a cross-functional environment
Certification
Certified Medical Coder - CPC, AAPC
Timeline
Senior Medical Coder
Optum, UnitedHealth Group
03.2025 - Current
Medical Coder - REMOTE
Vecode Healthcare LLC
06.2024 - 01.2025
Senior Executive - Medical Coding Auditor
SCIOInspire Holdings, EXL group
11.2022 - 06.2023
Senior Medical Coder
Omega Health Care Pvt. Ltd.
04.2021 - 10.2022
Junior Medical Coder
Avontix Global Solutions Pvt. Ltd.
01.2019 - 03.2021
Biology, Physics & Chemistry -
Sri Chaitanya Jr. College
Bachelor of Pharmacy -
Anurag Group of Institutions
Hobbies and Interests
- Certified Yoga Instructor
- Cooking
- Travelling
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