Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Usha Raju

Ashburn,VA

Summary

Job summary: I have 15+ experience as patient service oriented physician with bachelor degree in Medicine. Strong background in Public health, patient management pharmacology and Clinical documentation. I have experience in medical claims verification. I have managed patients in Primary care, cardiology and oncology departments. I have worked as a Medical officer in charge of multiple villages with 15,000 plus population.

Highly knowledgeable and experienced Clinical Documentation Improvement Specialist has strong analytical and critical thinking abilities and the understanding of documentation standards in the medical field.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Clinical case manager

Loudoun county public schools
Ashburn, VA
08.2021 - Current
  • Participate in data collection, analysis and reporting for program management and performance improvement
  • Align and support infectious disease mitigation practices across LCPS
  • Review Documentation
  • Review Concurrent medical record for compliance including completeness and accuracy for severity of illness and quality using the compliant Documentation Management Program
  • Collaborate with nurses and physician’s office to ensure accuracy
  • Support the management of care room operations within the schools
  • Collaborate with the office of procurement and risk management, the office of support services and other departments as necessary.

Manager

Karyo E-systems
Ashburn, Virginia
06.2017 - 08.2021
  • Organizing and overseeing individual and team training programs (both outsourced and in-house.)
  • Planning regular employee performance evaluations
  • Conducting skills gap analyses
  • Monitor and report on turnover rates
  • Develop employee retention programs and team building activities
  • Craft policies that support internal promotions
  • Create organizational charts and define each position’s responsibilities
  • Discuss career-pathing options with high-potential employees and their team leaders
  • Onboard new hires and coach employees and act as their consultant regarding learning and development activities
  • Managing Payroll

Drug safety associate

PPD pharmaceuticals
, North Carolina
01.2013 - 04.2015
  • Processed and distributed all safety reports received from any source (clinical trials and post-marketing) for assigned products and/or studies, according to ICH-GCP guidelines, regulatory requirements and company SOPs, policies, and procedures
  • Exercise judgment and use knowledge of FDA and ICH guidelines and product labeling in performing initial case assessment for seriousness and expectedness
  • Triage all domestic and foreign reports received by company, appropriately scheduling case reports in company safety database based on the following criteria: source, seriousness, and data entry priority, initial vs
  • Follow-up report
  • Perform MedDRA Coding of drugs, adverse events in company preferred data management systems and handle electronic submission (E2B) according to ICH guidelines
  • Generated narrative case summaries in company safety database according to company standards
  • Raise additional medical queries to pertinent adverse events
  • Responsible for initial evaluation and assessment of incoming case reports and source documentation for completeness, accuracy, legibility, and consistency of information, and performs necessary checks for duplicate cases
  • Enter appropriate data into safety database in a timely manner, utilizing management-determined data entry guidelines
  • Generated data listings from the safety database and Reviewed QC Data on Argus Software
  • Support and contribute to safety data reconciliation and in generating aggregate reports.

Medical Advisor/clinical documentation specialist, Third party administrator

TTK
Bangalore
08.2004 - 01.2011
  • Perform on-site or electronic coding and clinical validation audits and interpretation of medical documentation to capture of all relevant coding
  • Implement training and development of nursing staff ,physicians that address documentation
  • Responsible for compliance with organizational integrity through raising questions and promptly reporting actual or potential wrongdoing
  • Knowledge of regulatory environment
  • Complete accurate and concise input of data
  • Checking the status of patient’s medical insurance
  • Ensure that a patient’s insurance will cover required medical procedures or hospital stays
  • Verifying patient information, billing, medical coding, and conducting claims examinations
  • Also Educate the patient about their coverage
  • Authorizing and/or giving medical opinion on treatment of a patient based on his medical condition and Insurance coverage
  • Responsible for coordinating and supporting initiatives relative to the evaluation, processing, and handling of medical claims for various insurance companies
  • Act as a liaison between the organization, insurance companies, Claimants, policyholders regarding the status and eligibility for coverage for all medical claims

Sr. house officer

Narayana Health, Top, hospital
Bangalore
05.2001 - 07.2004
  • Provided clinical services like history taking, examining for signs and symptoms of cardiac ailments, managing treatment modalities and counseling under supervision of cardiologist
  • Assisting consultants in CCU and wards
  • Handling cardiac emergencies
  • Conduct surveys and interviews with patients in the hospitals to Collect data on diet, nutrition, lifestyle, environment, and genetic factors
  • Research work on correlation between metabolic syndrome, waist girth to coronary artery disease

Duty doctorBangalore Institute of Oncology
06.2000 - 05.2001
  • Treating cancer patients in the ICU and ward
  • Monitoring chemotherapy and Managing hospital admissions of patients with side-effects of cancer treatments
  • Updating the cancer patient’s status to the relatives
  • Receiving patients on emergencies either directly or from various departments, initiating investigation and treatment in consultation with the consultants
  • Preparing discharge summaries, fitness, certificates, discharge medication and death summaries (Mortality)

Medical Officer

Primary health Centre, Auranagabad
05.1996 - 05.2000
  • Provided primary care, urgent medical and nursing services (including resuscitation, stabilization and assessment and diagnosis, treatment and referral as necessary);
  • Assess the urgency and severity of presenting problems through history taking ,examination and investigation
  • And dispense treatment options and carrying out/referring for appropriate interventions and procedures, including but not limited to prescribing, minor surgery and other general practice procedures, counselling, psychological interventions, advising and education
  • Referral for diagnostic, therapeutic and support services as require
  • Provide timely clinical and culturally appropriate health services through -
  • Ongoing health and development assessment and advice
  • Appropriate screening, risk assessment and early detection of illness, disease, and disability
  • Interventions to assist people to reduce or change risky and harmful lifestyle behavior
  • Family planning services, provision of contraceptive advice and sexual health services
  • Ensure Immunization programs are available to the practice population
  • Working with public health providers in the prevention and control of communicable diseases and reporting to relevant public health officials
  • Ongoing care and support for people with chronic and terminal conditions to reduce deterioration, increase independence and reduce suffering linking, where relevant, with appropriate service providers
  • Conducting Ante Natal Checkup and deliveries
  • Ensuring smooth operations of National TB, Leprosy, Polio eradication programs
  • Ensure operational plans and effective implementation of the targets laid down by the National health programs, formulate village health and sanitation plan, keep close liaison with community leaders and representatives, block development officer and involve them to the best advantage in the promotion of health programs in the area
  • Provide leadership and guidance to programs on nutrition
  • Provide education in the community clinics for the prevention of diseases and assist patients in the management of acute and chronic medical conditions
  • Conduct safe motherhood and child survival programs
  • In collaboration with NGO’s facilitate mobile health camps in slums to treat and screen diseases
  • Collect and analyze data to assess community health needs by conducting free health checkup camps
  • Providing patient care and management to the underserved urban communities by facilitating public health care services, conducting child health clinics, school health, endemic disease clinic, immunization clinic, family planning and sexual &reproductive clinic

Education

PG - Post Graduate Diploma of Healthcare Administration

Institute Of Healthcare Administration
Chennai
03.2001

MBBS(Bachelor of Medicine Bachelor of surgery) - Medicine

Government Medical College
Nanded India
06.1994

Skills

  • Medical terminology, Clinical documentation, EHRM, Medical review Data mining ICD coding, DRG coding ,CMS guidelines , HCC ,HIPPA , clinical documentation integrity and risk adjustment practices, Pharmacovigilance, Report preparation , FDA guidelines

Certification

Veritas Healthcare solutions, New Jersey: -Clinical Research Associate 2012


Ministry of Health and family Welfare -Government of India :- National child survival and safe motherhood Certification 1996


Narayana Health institute of Cardiac Sciences:- Live Echo Complex congenital heart diseases basics and beyond 2002


Timeline

Clinical case manager

Loudoun county public schools
08.2021 - Current

Manager

Karyo E-systems
06.2017 - 08.2021

Drug safety associate

PPD pharmaceuticals
01.2013 - 04.2015

Medical Advisor/clinical documentation specialist, Third party administrator

TTK
08.2004 - 01.2011

Sr. house officer

Narayana Health, Top, hospital
05.2001 - 07.2004

Duty doctorBangalore Institute of Oncology
06.2000 - 05.2001

Medical Officer

Primary health Centre, Auranagabad
05.1996 - 05.2000

PG - Post Graduate Diploma of Healthcare Administration

Institute Of Healthcare Administration

MBBS(Bachelor of Medicine Bachelor of surgery) - Medicine

Government Medical College

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