SANJANA SUNKARA
Hyderabad
Summary
6.5 years in US healthcare with expertise in denial coding and claim analysis. Proven ability to ensure coding accuracy and compliance through thorough documentation review. Collaborates effectively with clinical teams to reduce denial rates and improve reimbursement processes.
Overview
8
8
years of professional experience
Work History
Senior Associate -Denial coding
Medico Healthcare Services And Technologies
HYDERABAD
02.2020 - 06.2025
- Analyzed insurance claim denials to identify root causes and determine corrective actions for improved reimbursement outcomes.
- Prepared and submitted appeals with supporting clinical documentation to effectively challenge denied claims.
- Corrected coding errors and resubmitted denied claims to maximize reimbursement and reduce revenue loss.
- Identified denial trends and collaborated with coding, billing, and clinical teams to implement corrective measures that enhance claim approval rates.
- Researched medical records, physician documentation, CPT, ICD-10-CM, and HCPCS codes to ensure coding accuracy and compliance.
- Ensured compliance with payer-specific guidelines, Medicare, Medicaid, HIPAA, and industry coding standards.
- Verified medical necessity and documentation requirements based on payer policies.
- Conducted root cause analysis for denials related to coding, documentation, medical necessity, and authorization issues, facilitating process improvements.
- Worked with physicians and healthcare providers to clarify incomplete or conflicting documentation.
- Monitored claim status and followed up with insurance companies to ensure timely claim resolution.
- Maintained productivity and quality standards while meeting turnaround time (TAT) requirements.
- Used electronic health records (EHR), encoder software, and practice management systems to review and process claims.
- Provided coding feedback and education to internal teams, contributing to a reduction in denial rates.
- Maintained up-to-date knowledge of ICD-10-CM, CPT, HCPCS, and payer policy changes.
Executive Coder & Verifier
Phycare Services Pvt. Ltd.
vijayawada
12.2017 - 06.2019
- Specialized in Physician coding, Medicine, Outpatient and Hospital coding along with E/M.
- Assigned and sequenced medical codes accurately, including ICD-9 & 10 CM and CPT codes, ensuring compliance with coding regulations.
- Consistently delivered 95% accuracy rate, supporting high-quality coding standards.
- Achieved a daily production of 100-110 reviews, ensuring timely processing of coding tasks.
Education
Masters of Pharmaceutical Sciences -
01-2017
Bachelor of Pharmacy -
01-2015
Skills
- Denial analysis
- Compliance Awareness
- Documentation review
- Coding Education
- Analytical Thinking
- Time management
- Adaptability
- Effective communication
Languages
- English
- Telugu
- Hindi
Technical Experience
Data Analysis with M.S Office & PPT Presentation to Client., AMD Practice fusion, eClinical works, CMS website, Find a code - NCCI Validator, Ncoder pro, CDC - BMI calculator, NPPES NPI registry, Flash code
Personal Information
- Father's Name: Srinivas
- Date of Birth: 08/13/94
- Gender: Female
- Nationality: Indian
- Marital Status: Married
Disclaimer
I, hereby declare that the information furnished above is true to the best of my knowledge and belief.
Timeline
Senior Associate -Denial coding
Medico Healthcare Services And Technologies
02.2020 - 06.2025
Executive Coder & Verifier
Phycare Services Pvt. Ltd.
12.2017 - 06.2019