Anu Priya

Detail-oriented and analytical Healthcare Professional with over 5 years of diverse experience spanning Clinical Nursing, Medical Coding, Insurance Management (CMCHIS), and Medical Record Review. Proven track record in evaluating complex health records, verifying documentation compliances. Combines strong clinical knowledge from a B.Sc.

Nursing background with hands-on expertise to deliver precise, compliant, and objective medical auditing. Equipped with strong English communication skills (IELTS Band 6) to effectively convey audit findings to cross-functional teams.

Client Service Executive (Medical Review (Mass tort) Auditor) - Medrona Billing Service Private Limited - Chennai, TN

(2024-09)

Ward Manager (Insurance Department - CMCHIS Auditor) - Government Medical College and Hospital - Thiruvallur, TN

(2022-05 - 2024-06)

• Audited 40-50 patient charts and clinical records daily for data accuracy under the Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS).
• Verified clinical procedures aligned with pre-authorizations and insurance guidelines, ensuring a 98% approval rate prior to final claim submission.
• Served as the primary liaison between hospital clinical staff and insurance authorities to resolve compliance discrepancies, accelerating claim turnaround times.

Associate (Medical Record Review & Summarization) - Aosta Software Technology - Chennai, TN

(2021-04 - 2021-07)

• Reviewed and analysed complex electronic health records (EHR) to synthesize 15-20 objective, highly accurate medical summaries per shift.
• Evaluated physician documentation for compliance, ensuring 100% of clinical updates, diagnoses, and treatments met industry standards.

Junior Medical Record Reviewer - Rapid Care - Chennai, TN

(2015-01 - 2016-01)

• Reviewed and analysed complex electronic health records (EHR) to synthesize 15-20 objective, highly accurate medical summaries per shift.
• Evaluated physician documentation for compliance, ensuring 100% of clinical updates, diagnoses, and treatments met industry standards.

Junior Medical Coder - Billed Right - Chennai, TN

(2008-02 - 2009-02)

• Audited physician clinical charts to extract and translate diagnoses and procedures into standard ICD/CPT medical codes with 95%+ coding accuracy.
• Mitigated compliance risks of upcoding or under coding penalties by cross-referencing clinical documentation against official coding manuals.

Staff Nurse - Soorya Hospital - Chennai, TN

(2007-04 - 2007-12)

• Leveraged clinical expertise to monitor patient health and manage documentation, providing a strong clinical foundation for medical necessity reviews.

B.Sc. - Nursing - SRM College of Nursing, Ramapuram (M.G.R. University) (2007)