nischal pakerla

Skilled and 14 years experienced Revenue Cycle Specialist has strong knowledge of medical
billing and coding practices. Knowledgeable about insurance companies, prior authorization
protocols, submission, and reimbursements. Has a professional Certificate in Medical Coding as
a Certified Coding Specialist from American Health Information Management.

Ensure effective claims submission and re-submission. (All areas pertaining to a
hospital -OP, Daycare, IP, ER)
Ensure effective use of 3M. IR-DRG identification and H.I.S module to support
reimbursement efficiency in line with physician documentation needs for an insurance
claim.
Review rejection trends based on denial codes due to medical necessity & other
rejection areas; suggest corrective improvements and education where required.
Work with physicians in supporting education needs to reduce insurance rejections.
Identify issues faced from registration and billing, which affects the overall claims and
suggest improvements required.
Resubmitting claims with proper justification and required documents as per denial
code within time limits.
Initiating reconciliation for the closure of financial year with clinician justification and
required documents.
Assigning appropriate ICD-10/CPT codes as per coding/DOH guidelines.
Requesting approval for the services which need prior authorization based on
insurance guidelines with all required documents and resubmitting the rejected
approvals with proper justification and required documents within time limit.
Follow up with payers for rejected claims and escalating to clinician for justification of
the services.
Identify physician education programs with the Revenue Cycle Manager for corrective
improvements to reduce medical necessity denials and improve DRG efficiency.
Work with HIS, IT and operational teams to allow smooth flow of claims processes.
Assess opportunities to improve internal workflows; ensure best methods and tools
are utilized.

Masters in Biotechnology