GADDAM MOUNIKA

Email:gaddammoni@gmail.com Mobile no: +918497905938

Summary:
Professional medical claim processor with 6 +years of experience in processing and coding claims. Extensive
knowledge in the area of claims resolution. Well-developed oral and written communication skills. Identify trends
in denials and implement resolution measures. Sound knowledge of medical and insurance terminologies and
coding guidelines.

Highlights:

1.Responsible for detailed research on client questions to validate the denials and provide accurate and
comprehensive response.

2.Daily, weekly and monthly reports

3.Proficient with claims processing software

4. Accountable and responsible for handling a Process, Transition, multitasking and deliverances within TAT.

5. Perform claims analysis to track provider reporting trends like unbundling, modifier misuse, multiple claim
submission, multiple units etc.

Work Experience:
From 2015 December to present, working as a Senior Analyst – Client Services in Cotiviti India Private
Limited, Hyderabad.

1.Delivering offshore support for over 36 Payers in US for denied claims (ex: Humana, Blue cross blue shield,
Molina, Aetna, Anthem, Health alliance, Excellus, Point 32, Devoted, Dean, Cigna, Wellmark, wellcare etc..)

2. Implementation of Client specific policies through each release cycle to keep consistent with current Industry
payment guidelines and conduct production audit.

3. Providing resolutions to Policy, Adhoc & Payment related inquiries by using references of CMS(LCD,OCE data
files, NCCI, MPFSRVF, IOMS, etc..)

4. Providing new policies to the clients by review of payment guidelines from (CMS/State Medicaid/Medical
specialty associations/Payer Health plans/ IOMs/etc)

5. Data and report analysis on various requirements as requested by the Client/ Client teams pertaining to
Coding, Billing, Payment Methodology and Policy standards of the industry and client customization.
6.Arriving at derivations by performing thematic claims trend analysis (High Dollar claims review/high
frequency/provider billing trends/etc) and update the client teams for looking at the potential opportunities or
missed opportunities.

7. Effective communication with various members of Client Teams.

8. conduct process training and mentor resources

9. Develop Training job aids/Process documents/production metric

10. Familiar with CMS & RCM regulatory requirements.

Certifications:
CPC (CERTIFIED PROFESSIONAL CODER):

Conducted by American Academy of Professional Coders (AAPC)

Pass Out: August 2017.

Education:
M.PHARMACY (PHAR.ANALYSIS & QUALITY ASSURANCE):

Aggregate - 78%

Affiliated To JNTUH

Pass Out: 2015– 2017.

B. PHARMACY:

Aggregate – 79.04%

Affiliated to Satavahana University

Pass Out: 2011– 2015.

Skills:
MS-Excel
Word
PowerPoint
Outlook

Personal Details:
Father Name : Rajamouli
Mother Name : Satyamma
Date of Birth : 05 July 1994
Gender : Female
Nationality : Indian
Languages : English, Telugu & Hindi
Address : 6-102, Basanthnagar, Peddapalli, Telangana, 505187

Declaration:
I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility
for the correctness of the above-mentioned.