Watching OTT series, Listening Music, Reading Books
Himavathi Polagoni
Sr. Medical Coder/Insurance Pre- Authorization
Hyderabad
Summary
Healthcare professional with 7 years and 10 months of experience in the healthcare industry, including 3 years in Insurance Preauthorization and 4 years and 10 months as a Senior Medical Coder. Experienced in medical record review, insurance eligibility verification, prior authorization processing, medical coding, and ensuring compliance with payer-specific guidelines. Proficient in reviewing clinical documentation, identifying coding discrepancies, maintaining coding accuracy, and supporting quality assurance initiatives. Strong understanding of medical terminology, ICD-10-CM, CPT, HCPCS, and healthcare revenue cycle management. Committed to maintaining high productivity, ensuring regulatory compliance, and delivering accurate, timely, and quality-driven results.
Overview
3
3
Languages
1
1
Certification
7
7
years of professional experience
Work History
Senior Medical Coder
Data Marshall
2019.12 - 2023.11
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records with industry standards.
- Conducted regular audits of coded data, pinpointing inconsistencies or inaccuracies that could impact reimbursements or compliance measures.
- Mentored junior coders, enhancing coding accuracy and efficiency through targeted training sessions.
- Maintained ICD-10 proficiency, leading to more accurate code assignments and fewer claim rejections.
- Resourcefully used various coding books, procedure manuals, and on-line encoders- Optum 360, ICD 10.COM.
- Time management skills were utilized effectively to balance competing priorities under tight deadlines.
- Contributed to quality improvement initiatives by identifying areas for potential enhancement within the medical coding department.
- Contributed to the growth of the organization by consistently meeting or exceeding productivity targets while maintaining high-quality standards.
- Utilized electronic medical record systems to store, retrieve and process patient data. EMR such as, MIRA, Harris Caretracker, ECW: e-clinical work, Optum 360
Insurance Preauthorization
Digital Transformation Consulting
2023.12 - 2026.09
- Conducted thorough pre-authorization checks for insurance coverage confirmation before medical procedures.
- Coordinated with insurance companies to verify coverage details and obtain authorizations for procedures, preventing billing issues or delays in treatment plans.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Maintained up-to-date knowledge of insurance policies and changes, aiding in accurate verification.
- Streamlined insurance verification processes, minimizing billing errors and improving revenue cycle management.
- Reduced manual data entry errors, implementing automated verification tools for insurance eligibility checks- BOT Tool
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Contributed to increased hospital revenue by diligently verifying insurance coverage and obtaining necessary preauthorizations.
Education
Bachelor of Science - Biotechnology, Zoology, Chemistry
Government Degree College For Women
Hyderabad, India 2001.05 -
Skills
Diagnose and procedures coding (ICD-10 and CPT)
HEDIS Measures
Precertification processes
Insurance eligibility verification
Medical record review
Medical terminology
Electronic health records
EMR software proficiency
Quality Assurance
MS Office proficiency
Decision-making
Insurance products
Additional Information
Personal Qualities:
- Self-motivated and passionate to succeed.
- Quick learner
- Good verbal & oral communication skills
- Flexible (adaptability)
Interests
Certification
Certified Professional Coder (CPC)
Timeline
Insurance Preauthorization
Digital Transformation Consulting
2023.12 - 2026.09
Senior Medical Coder
Data Marshall
2019.12 - 2023.11
Bachelor of Science - Biotechnology, Zoology, Chemistry
Government Degree College For Women
2001.05 -