Dr. j subhash

Clinical Investigator @ Optum

About

I am a dedicated and knowledgeable medical Claims Specialist with extensive experience in preventing potentially fraudulent and abusive claims. My expertise encompasses a thorough understanding of ICD .HCPCS CPT/diagnosis codes, CMC guidelines, and client-specific directives, coupled with a steadfast adherence to state and federal compliance policies. Over the years, I have honed my skills in analyzing and reviewing claims, high quality in maintaining accuracy ensuring they meet all necessary guidelines and regulations.My professional journey has been marked by a commitment to maintaining the integrity of the claims process. By leveraging my medical expertise and comprehensive knowledge of various coding systems, I consistently prevent inappropriate payments and safeguard the interests of clients and members alike A comprehensive knowledge in US healthcare Evaluation and management & Multi speciality and Emergency Department coding.US healthcare medicare/Medicaid

Country

India

City

Hyderabad

Industry

Hospital & Health Care

Skill

Electronic Health Records (EHR), Fast Healthcare Interoperability Resources (FHIR), FHIR Interoperability, Core Payer-Provider Workflows, Agile Practices, Healthcare IT Functional Roles, EDI Transactions, Understanding of Scrum Framework, Agile Mindset & Principles, scrum events, Scrum roles and responsibilities , Scrum Artifacts , Basic Scrum Implementation, Team Collaboration, problem solving adaptability , Time Management, effective communication , Healthcare Information Technology (HIT), Artificial Intelligence for Business, Generative AI Tools

Experience

Clinical Investigator

Optum

2024-7 - Present · 2 yrs 3 mos

Hyderabad, Telangana, India

Reviews prepay claims Medicare& Medicaid with corresponding medical records to determine payment accuracy Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review Participates in regulatory meetings with client Participates in meetings with providers, advocates and legal to assist with provider abrasion Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution Continuous monitoring of claim inventory in order to adhere to performance guarantees

Physiotherapist

MOTUS PHYSIO AND PILATES CLINC

2023-8 - 2024-4 · 9 mos

Gachibowli

Help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. Movement, tailored exercise and physical activity advice .Exercises designed to improve movement and strength in a specific part of the body