Bhagyashri Racha

Having experienced more than 15 yrs in the medical field with solid clinical competence, rapid decision-making, and strong interpersonal and stress-management skills. Have a strong foundation in clinical assessment and standard treatment guidelines to manage cases efficiently and respond to initial emergencies. In search of the position of a Sr.

RMO with reputed & growing hospitals, to ensure full attention is given to solving patients' conditions in terms of assessing, diagnosing, and treatment. With the added advantage of having a diploma in health insurance & management, with keen interest in the health insurance field and experience of working as a TPA medical officer.

Teleconsultant - Lifenity Healthcare limited

(2024-07 - 2026)

• Assessing patients on call by reviewing lab reports, ongoing complaints, evaluating the previous history providing them live counselling and treatment and referring to higher centres for any critical lab values or symptoms with quick assessment.

TPA Medical officer - Inlaks hospital Chembur - Chembur, Mumbai

(2023-07 - 2024-07)

Serving as a key link between hospital, patients, and insurance companies by managing the entire health insurance process, ensuring smooth claim settlement in compliance with policies.

• Handle insurance claim processing, verification, and submission to TPAs for both cashless and reimbursement claims, ensure compliance with hospital and TPA protocols.
• Reviewing pre-authorization requests for IPD & surgeries with proper ICD coding, and alignment with insurance policy terms.
• Coordinate between hospital billing departments, patients, and insurance providers to ensure accurate documentation.
• Guide patients and their families regarding insurance eligibility, approval status, and claim procedures.
• Maintain updated records of all TPA-related activities, claim approvals, rejections, and pending cases.
• Answering all the queries put forth by the insurance companies efficiently and promptly in the process of taking approval.
• Expertise in solving complex queries by preparing justified medical summary in approval pending cases.
• Analysing medical bills, managing implant reconciliations, and solving billing discrepancies between the hospital and insurance TPAs.
• Assess and manage complex inpatients and acute admissions when needed.
• Immediate senior responder during critical clinical emergencies like trauma or cardiac events.
• Stabilizes unstable patients and situations and escalate by taking necessary action in coordination with consultants.
• Guides and monitor junior RMOs, house surgeons, and medical interns.
• Assists in organizing shift schedules, clinical handovers, and routine operational checks.
• Maintain clear communication between nurses, consultants or on-call specialists when needed.
• Ensures accurate medical documentation, progress charting, and the timely generation of discharge summaries.

Senior RMO - Acme Multi Hospital - Chembur, Mumbai

(2022-05 - 2023)

Worked as sr. RMO for multiple roles managing indoor n outdoor patients, new admissions, managing preoperative & postoperative measures on a daily basis.

• Handling insurance related documentation, answering the queries, taking preapprovals for the surgery.

General Practitioner - Gurukripa Clinic

(2017-03 - 2022-01)

Senior RMO - Sushrut Hospital & Research Centre - Chembur, Mumbai

(2016-10 - 2017)

Worked as Sr.RMO handling all kinds of patients carrying out rounds, managing patient care, as the primary bridge between patients, nursing staff, and senior consultants by conducting ward rounds, supervising treatments, assessing patient daily status.

• Diagnose and manage acute and chronic medical conditions.
• Prescribing medications, treatments, therapies as necessary.
• Monitor patients' progress and response to treatment, adjusting care plans and interventions as needed to ensure optimal outcomes.
• Responding promptly to medical emergencies and code blue situations, providing advanced life support and resuscitation as required.
• Communicate effectively with patients and their families, providing information, education.
• Document all patient vitals, assessments, interventions, and outcomes accurately and timely in the electronic record (EMR) system.

Assistant Medical Officer - Unique Hospital - Solapur, Maharashtra

(2006-01 - 2006-07)

Independently carried out labour procedures, assisted to Gynace & OB surgeries.

Resident Medical Officer - Shri Markanday Sahakari Rungnalay Multispeciality & Research Centre - Solapur, Maharashtra

(2006-10 - 2010-04)

R.M.O.ship in various depts of Medicine & Surgery, Emergency & Casualty Dept, Intensive Care Unit, cardiac Cath lab, all in all experienced all the faculties possible during the four year long tenure. All lifesaving procedures, emergency cases and casualties handling.

• Serve as the first point of contact for patients arriving in casualty/emergency.
• Promptly handle medical emergencies and provide immediate stabilization before a senior consultant arrives.
• Quickly assess and prioritize patients and obtain detailed medical histories.
• Provide immediate treatment to emergency patients.
• Refer patients to specialist departments if needed.
• Maintain emergency medical records and reports.
• Coordinate with trauma and surgical teams.

PG Diploma - Health Insurance & Management - Symbiosis Pune (2025)

Course - Health Research Fundamentals - NPTEL (2026)

PG Diploma - Clinical Research & Regulatory Affairs - Haffkine Institute Mumbai (2015)

Bachelor of Ayurvedic Medicine and Surgery - BAMS - Nashik University (2006)

Higher Secondary Certificate - Science - Pune Board (2000)

Secondary School Certificate - Pune Board (1997)