Hi, I’m
Dr.Sharanya Challapalli
Dubai
Summary
Knowledgeable Inpatient Clinical Documentation/Case Management specialized in Coding, Auditing and Documentation review. Talented at correcting and resubmitting claims, and reviewing health records to identify proper relationships between procedure and diagnosis codes. Offers 5+ year background in reviewing, analyzing and managing medical record information to identify appropriate coding and approvals.
Overview
7
years of professional experience
5
Certification
Work History
MetLife Gulf
Inpatient Claims Approval and Case Manager
07.2022 - Current
Job overview
- Collaborated with an interdisciplinary team to determine timely services of Inpatient approvals.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner arranging SMO / Home country Treatment / Courtesy calls.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues / providers to optimize client support strategies.
- Monitored ongoing admission cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Worked effectively in fast-paced environments.
- Ensured compliance with relevant regulations by staying current on updates related to ICD-10-CM/PCS guidelines, CPT codes, HCPCS Level II codes, modifiers usage rules.
- Contributed to revenue optimization through diligent assignment of appropriate diagnostic and procedural codes.
- Improved overall coding quality by conducting regular audits, identifying areas for improvement, and providing targeted training to team members to determine accuracy and compliance with coding guidelines.
- Acted as a subject matter expert on inpatient coding by consulting with other departments within the organization on code assignments and documentation requirements.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services and local Governing body DHIC guidelines to assign diagnostic codes.
- Used critical thinking to break down problems, evaluate solutions and make decisions for High cost claims / Outlier Payments/ Add-On Payments.
- Reduced care costs without sacrificing quality through service coordination and multidisciplinary collaboration.
- Learned and adapted quickly to new technology and software applications.
Prime Multispecialty Hospital
Inpatient Clinical Documentation Coding Specialist
12.2019 - 01.2022
Job overview
- Applied official ICD 10-CM / CPT coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Perform initial charts reviews and assign working DRG within 24 hours of admission, on the working days.
- Assist in the development of compliant diagnosis/DRG specific queries to aid physicians with proper and precise documentation.
- Maintain up to date working DRG and has clear strategies to effectuate improved quality of clinical documentation for all the select cases.
- Processed and tracked requests for medical records from external organizations.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Facilitated communication between medical staff and billing department, ensuring seamless flow of information for accurate claim processing.
- Streamlined coding procedures with process improvements, resulting in faster turnaround times for claims submissions.
- Trained and mentored junior coders to support growth and development amd apply high-quality coding practices.
- Contributed to revenue optimization efforts by identifying under-coded services and providing recommendations for appropriate code assignments.
- Developed training materials to educate staff on current coding standards, best practices, and regulatory requirements.
NMC Multispecialty Hospital
Inpatient DRG Coding and Billing
09.2018 - 12.2019
Job overview
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in Inpatient medical records.
- Performed billing and coding procedures for ambulance, emergency room, inpatient and outpatient services.
- Initiated, performed and documented quarterly coding audits for physicians.
- Provided administrative support to physicians and interpreted medical reports and data to assign ICD-10 codes and CPT , HCPCS; entered diagnosis codes and patient information into billing software.
- Updated and managed diagnosis lists, coordinated routine documentation and coding audits, and executed qualitative analyses of discharged charges.
- Followed and maintained currency on coding, sequencing, and procedures' best practices and updates.
- Reviewed and validated accuracy of charges, including dates of service, services provided, location, patient identification, and provider signature.
- Ensure to follow DHA guidelines and regulations.
AGS Health PVT.Ltd
Inpatient DRG Medical Coding Associate
03.2016 - 03.2018
Job overview
- Prioritized tasks to meet tight deadlines, pitching in to assist others with project duties.
- Managed a diverse team of professionals, fostering an inclusive work environment that encouraged collaboration and innovation.
- Reviews and interprets medical information, physician treatment plans, courses, and outcomes to determine appropriate ICD/CPT /PCS codes for diagnoses and procedures.
- Keeps informed of the changes/updates in the ICD/CPT/PCS by attending appropriate training, reviewing coding clinics and other resources and implements these updates in their daily work.
- Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures.
- Utilizes technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-10 CM/ PCS diagnoses and procedures.
Sri Rama Multispecialty Dental Clinic
General Practitioner Dentist
11.2013 - 01.2016
Job overview
- Completed consultations with patients for treatment plan.
- Took impressions for retainers and appliances.
- Stayed current on industry advancements through continued education courses and professional development opportunities.
- Wrote prescriptions for antibiotics and other medications used to treat temporary or long-term dental issues.
- Communicated one-on-one with patients during consultative appointments to explain treatment plan and educate on upcoming procedures.
- Efficiently diagnosed and treated periodontal diseases through scaling, root planing, and other non-surgical methods.
- Reduced patient anxiety with empathetic communication and clear explanations of procedures.
- Skillfully performed various restorative procedures such as fillings, crowns, bridges, and dentures to restore patient smiles.
- Diagnosed and treated infections, mouth ulcers, and other problems with oral mucosa.
- Performed comprehensive oral health assessments, including dental X-rays, to identify and diagnose issues early on.
- Maintained detailed records of patient diagnoses, treatments, and progress for continuity of care.
- Managed complex extractions skillfully while minimizing patient discomfort and reducing complications.
- Consulted with other dental professionals to deliver best patient care.
- Utilized modern anesthesia techniques to ensure minimal discomfort during procedures for all patients.
- Referred patients to specialists such as orthodontists, endodontists and oral surgeons based on individual needs.
- Improved patients' oral health by educating on better brushing and flossing habits.
Education
KLR'S Lenora Institute of Dental SciencesRajahmundry, India
Bachelor of Dental Surgery from Dentistry (Pre-Dentistry)
10.2013
University Overview
- Awarded Best Outgoing Student of the Year.
- Awarded as Topper for Prosthodontics,Periodontics,Community Dentistry,Conservative and Endodontics Departments.
- Received Colgate Sponsored Scholarship for Outstanding performance in Second and Final
Year of College.
Skills
- Case Management
- Documentation proficiency
- Proficient in 3M Encoder
- Problem-Solving / Decision making
- CPT®, CDT ,ICD-10-CM, and
HCPCS Level II codes - Mayo Clinics reference
- Merck's Manual Reference
- AMA CPT Assistant
- DRG Assignment - MS-DRG,APRDRG,
Medicaid-DRG,IR-DRG - Knowledge on MS Excel, Word, Outlook and PPT
- Excellent communication skills
- Time management
Certification
· CDIP Certified - AHIMA (2777273)
· CPMA Certified - AAPC (01552696)
· CCS Certified - AHIMA (2777273)
· CPC Certified - AAPC (01552696)
· CPHQ Certified - NAHQ (359899)
· LSSGB - Training
Languages
English
Bilingual or Proficient (C2)
Hindi
Upper intermediate (B2)
Telugu
Bilingual or Proficient (C2)
Malayalam
Beginner (A1)
Arabic
Beginner (A1)
Affiliations
- Dental Council of India
Timeline
Inpatient Claims Approval and Case Manager
MetLife Gulf
07.2022 - Current
Inpatient Clinical Documentation Coding Specialist
Prime Multispecialty Hospital
12.2019 - 01.2022
Inpatient DRG Coding and Billing
NMC Multispecialty Hospital
09.2018 - 12.2019
Inpatient DRG Medical Coding Associate
AGS Health PVT.Ltd
03.2016 - 03.2018
General Practitioner Dentist
Sri Rama Multispecialty Dental Clinic
11.2013 - 01.2016
KLR'S Lenora Institute of Dental Sciences
Bachelor of Dental Surgery from Dentistry (Pre-Dentistry)
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