Sushma Kaipa
Pittsburgh,PA
Summary
Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
2
2
years of professional experience
Work History
Senior Analyst
R1 RCM Global Pvt. Ltd.
11.2022 - 07.2023
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Maintained high accuracy rate on daily production of completed reviews.
- Actively maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third party requirements regarding billing.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Communicated with healthcare personnel, including practitioners to promote accuracy.
- Interpreted medical reports to apply appropriate ICD-10 CPT and HCPCS codes.
- Verified proper coding, sequencing of diagnoses and accuracy of general surgical procedures.
- Quickly responded to staff and client inquiries regarding CPT codes.
- Maintained a high level of productivity while consistently meeting deadlines for claim submissions.
Senior Client Partner
Access Healthcare Services Pvt. Ltd.
08.2021 - 11.2022
- Reviewed clinical data from medical records to assign ICD, CPT and HCPCS codes.
- Responded to coding questions from callers and other internal departments.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Accurately assigned codes using software and official print copy of code book.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Assigned value codes and modifiers to provide specific information for services provided.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
- Collected documentation and clarified ambiguous patient care statements by contacting providers.
- Collaborated with billing team to confirm no additional diagnosis codes available for LCD and NCD coverage.
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Education
CAHIMS
Certified Professional Coder
AAPC
11.2017
Skills
- HIPAA Compliance
- Claims Processing
- Clinical Documentation
- Medical record security
- Medical Terminology
- Insurance Verification
- Proficiency in Epic, Cerner, Athena, 3M
- Knowledgeable in ICD 10, CPT, HCPCS
Timeline
Senior Analyst
R1 RCM Global Pvt. Ltd.
11.2022 - 07.2023
Senior Client Partner
Access Healthcare Services Pvt. Ltd.
08.2021 - 11.2022
CAHIMS
Certified Professional Coder
AAPC
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