Medical Report Writer – Life Care Plans - National Brain Injury Institute (Houston, USA) - WFH
(2024-07)
Develop Life Care Plans for catastrophic injury cases, assessing future medical needs, treatment recommendations, healthcare utilization, life expectancy, and lifetime medical costs through comprehensive medical record analysis.
- Prepare detailed Life Care Plans (LCPs) based on comprehensive review and analysis of patient's electronic medical records (EMR/EHR), physician reports, diagnostic findings, operative notes, injury related assessments, therapy records, and specialist evaluations.
- Analyze and document future medical recommendations including physical therapy, chiropractic care, pain management, surgical procedures, specialist consultations, assistive devices, and long-term rehabilitation services.
- To communicate with U.S.-based physicians, nurse practitioners (NPs), and other healthcare providers to discuss patient's Life Care Plans, clarify clinical findings, and obtain recommendations for ongoing treatment and future care needs.
- Estimate lifetime medical costs associated with recommended treatments, therapies, medications, home care, DTI, Neurological assessments Battery, and future healthcare requirements.
- Evaluate long-term care requirements related to catastrophic injuries, disabilities, and ongoing rehabilitation needs.
- Calculate life expectancy using standard life expectancy tables, medical conditions, comorbidities, and clinical factors to support future care projections.
- Prepare chronological medical timelines outlining injury history, treatments, surgeries, hospitalizations, and ongoing medical care.
- Review and interpret complex medical documentation to identify current, and future healthcare needs of patients.
- Prepare and organize medical chronology reports highlighting key clinical events, diagnoses, procedures, and treatment progression.
- Utilize strong analytical and critical-thinking skills to assess treatment necessity, duration of care, and project healthcare utilization over a patient's lifetime.
- Analyze physician recommendations and clinical guidelines to project future care requirements and anticipated medical expenses.
- Reviewed imaging reports, operative notes, therapy records, pharmacy records, and specialist evaluations to support life care planning documentation.
Assistant Manager – Quality Assurance, Medical Summarization & Underwriting Support - Telegenisys India Private Limited - California - WFH
(2022-06 - 2024-05)
Managed a team medical underwriting support associates, overseeing quality assurance, medical summarization, underwriting support, training, workflow, and case delivery.
- Provided mid-level management and supervised a team of Medical Underwriting Support Associates, managing daily operations, workflow allocation, productivity, and timely case delivery within defined TATs and client SLAs.
- Conducted QA reviews and audits of medical record summaries and underwriting reports, ensuring accuracy, completeness, consistency, and adherence to underwriting guidelines.
- Reviewed and summarized EMRs, physician notes, diagnostic reports, and treatment histories to support medical underwriting and insurance risk assessment.
- Analyzed applicant medical information to identify chronic conditions, significant medical history, clinical red flags, missing records, inconsistencies, and documentation gaps relevant to underwriting decisions.
- Coordinated with underwriting teams to clarify medical documentation, resolve discrepancies, and ensure accurate representation of relevant clinical information.
- Provided training, mentoring, and feedback on medical terminology, record review, summarization techniques, quality standards, and underwriting requirements.
- Monitored team performance, productivity, quality, and TATs, conducted team meetings and training sessions, and prioritized urgent cases to meet client deadlines.
- Supported workflow and process improvements to enhance review quality, operational efficiency, and case processing timelines.
Senior Healthcare Reviewer – Claims Denial Specialist & Medical Records Reviewer - Translingua Private Limited
(2018-03 - 2022-04)
Worked across multiple healthcare and insurance clients and projects, including Saudi healthcare claims, medical records summarization, Quality check, and medical underwriting support. Specialized in claims denial analysis, clinical documentation review, discrepancy identification, and claim resolution.
- Analyzed rejected and denied Saudi healthcare claims to identify denial causes and documentation discrepancies.
- Compared claims with medical records and physician documentation to identify clinical and billing discrepancies.
- Identified claim and documentation issues and supported appropriate correction, resubmission, and escalation.
- Performed quality checks across medical records and project deliverables for accuracy for U.S & U.K Healthcare, completeness, and compliance.
- Supported medical records summarization and underwriting projects, including extraction of relevant patient information for insurance assessment.
- Managed claim correction, resubmission, and escalation based on denial findings.
- Collaborated with physicians, coding, billing, and claims teams to resolve claim-related issues.
Senior Medical Records Summarizer - Innodata India Private Limited
(2014-12 - 2018-01)
Specialized in U.S. healthcare medical record review, medical summarization, medical data abstraction, quality assurance, and team training, with progression to a QA role within one year.
- Review, analyze, and summarize extensive electronic medical records, physician notes, diagnostic reports, treatment plans, and hospital documentation for U.S. healthcare.
- Started as a Medical Summarizer and was promoted to a Quality Assurance (QA) role within a year in recognition of consistently strong performance and in-depth domain expertise.
- Performed Quality Assurance (QA) reviews of medical summaries and reports prepared by team members to ensure accuracy, completeness, consistency, and compliance with client requirements.
- Trained and onboarded new team members on medical summarization processes, documentation standards, and client-specific guidelines to ensure production readiness and high-quality deliverables.
- Medical data abstraction.
- Prepared accurate, well-structured medical summary reports from electronic medical records (EMR/EHR) in accordance with client-specific requirements, documentation standards, and quality guidelines.
- Reviewed and evaluated the work of new team members, providing constructive feedback, mentoring, and corrective guidance to ensure high-quality deliverables and readiness for live production assignments.
Resident Doctor / Assistant Doctor - Multiple Hospitals (Inamdar Hospital, Deena Nath Mangeshkar Hospital and Research Center, Kagali Hospital) - Pune, Maharashtra
(2011 - 2014)
Worked as a Resident Doctor/Assistant Doctor across multiple hospitals in Pune, Maharashtra, gaining clinical experience in patient evaluation, diagnosis, & treatment.
