Rinki Dhoundiyal

• Efficiently retrieved and managed patient records utilizing Epic, Sovera 10, ServiceNow, and Cerner platforms, ensuring precise check-in processes, reconciliation, and follow-up of missing or incomplete documentation.
• Coordinated directly with physicians and points of contact (POC) to resolve any discrepancies in physician orders and clinical documentation, ensuring accuracy to prevent insurance denials or payment rejections.
• Handled tasks related to validation, indexing, History & Physical (H&P) and Emergency Room (ER) records monitoring, ensuring completeness and readiness for billing and coding.
• Distributed workloads and managed team workflow to meet organizational Turnaround Time (TAT) targets without compromising quality.
• Facilitated team collaboration and performance improvement through quality audits, mentoring during PIP, and developing production and quality dashboards to maintain operational consistency and high standards.
• Delivered training sessions to new hires and existing staff on chart documentation protocols, compliance standards, and internal SOPs.
• Maintained highest standards of data confidentiality and HIPAA compliance in all HIM and RCM functions.

• Verified patient insurance eligibility and benefits prior to services to ensure accurate billing and minimize claim rejections.
• Prepared and submitted claims using ICD, CPT, and HCPCS coding systems, ensuring compliance with payer and regulatory guidelines.
• Reviewed and reconciled patient accounts, posting payments, adjustments, and handling refunds in the EHR and billing software (Epic, Cerner).
• Followed up on unpaid or denied claims, performed claim appeals, and resolved discrepancies with insurance companies.
• Conducted regular audits of billing records to identify and correct errors, ensuring revenue integrity, and compliance.
• Generated reports and analyzed billing trends to identify inefficiencies, reduce errors, and improve collection processes.
• Coordinated with physicians, clinical staff, and patients to clarify charges, obtain missing information, and resolve billing issues.

• Documented real-time patient encounters during virtual consultations, creating structured notes (SOAP, H&P, discharge summaries, and physician orders) in the EHR to capture complete patient histories and treatment plans.
• Entered and monitored lab, imaging, and diagnostic test results in the EHR to support timely physician decision-making.
• Performed a quality review of the documents and dictations, ensuring the accuracy of medical terminology, diagnostic reports, and overall documentation standards.
• Collaborated with physicians to review and finalize records, correcting any discrepancies found during the quality audit to ensure completeness and readiness for coding and billing.
• Consistently met turnaround time (TAT) targets in a fast-paced environment, while maintaining HIPAA compliance and 99% documentation accuracy.

Key responsibilities:

• Entered and updated patient health information into Electronic Medical Records (EMR) systems.
• Created and reviewed personal injury and worker’s compensation case files to identify errors or missing information.
• Documented comprehensive medical summaries for each case to support reviews and decision-making.
• Ensured accuracy and timely submission of reports for insurance processing and claims.
• Monitored and tracked case progress, following up on pending approvals or clarifications to ensure deadlines were met.
• Maintained strict adherence to HIPAA and organizational confidentiality standards in all patient documentation and data handling.