Senthamil Rajan

Detail-oriented and Certified Professional Coder (CPC) with 1.2 years of experience as a Medical Coder at PRO1 Health System and MSDEE Healthcare Service Private Limited. Proficient in ICD-10-CM, CPT, HCPCS, Evaluation & Management (E&M) coding, and Medical Decision Making (MDM) guidelines, with hands-on expertise in HCC risk adjustment projects for Aetna and BCBS. Consistently achieved a 96% coding quality score while ensuring accurate code assignment, compliance, and timely claim processing.

Skilled in clinical documentation review, coding audits, and maintaining high standards in revenue cycle management.

Medical Coding trainee at PRO1 Health System Private Limited (2025-05 – 2025-11)

Duration: 7 Months

• Performed accurate HCC risk adjustment coding for Aetna and BCBS insurance projects.
• Applied ICD-10-CM, CPT, and HCPCS coding guidelines to ensure compliant and precise medical claim submissions.
• Maintained an outstanding coding quality score of 96%, consistently exceeding organizational benchmarks.
• Reviewed clinical documentation to identify and capture all relevant diagnoses for appropriate risk score assignments.
• Collaborated with the quality team to address coding discrepancies and ensure continuous improvement.

Junior Medical Coder at MSDEE Healthcare Service PVT. LTD. (2024-08 – 2025-02)

Duration: 7 Months

• Assisted in medical coding and claim processing using ICD-10-CM, CPT, and HCPCS standards.
• Reviewed patient medical records and clinical documentation to ensure coding accuracy and compliance.
• Supported senior coders in maintaining quality standards and timely claim submissions.
• Participated in coding audits and continuous learning sessions to improve coding proficiency and productivity.

Insurance Manager – Medical Oncology at Thanjavur Medical College Hospital (TMCH) (2020-12 – 2024-05)

Duration: 4 Years

• Managed end-to-end insurance operations within the Medical Oncology department for 4 years.
• Coordinated insurance pre-authorizations, claim submissions, and follow-ups to ensure timely and accurate reimbursements.
• Liaised between insurance providers, oncology clinicians, and billing departments to resolve claim disputes efficiently.
• Maintain accurate patient insurance records and ensure compliance with payer-specific policies and guidelines.

Bachelor of Engineering in Mechanical Engineering – St. Joseph College of Engineering and Technology (2020)