Vinjusha Kv
Clinical Reviewer (Current)
About
Review clinical documents and medical records for accuracy, completeness, and compliance. Evaluate medical necessity based on clinical guidelines and standard treatment protocols. Analyze diagnoses, investigations, treatment plans, and hospital records.
Experience
Clinical Reviewer (Current) - RedRoad Health Solutions Pvt. Ltd. - Bengaluru, Karnataka
(2024-01 - 2026-02)
- Review clinical documents and medical records for accuracy, completeness, and compliance.
- Evaluate medical necessity based on clinical guidelines and standard treatment protocols.
- Analyze diagnoses, investigations, treatment plans, and hospital records.
- Support utilization management and clinical decision-making processes.
- Coordinate with physicians and healthcare providers to obtain additional clinical information when required.
- Ensure quality, confidentiality, and timely completion of clinical reviews.
- Maintain accurate documentation while adhering to company policies and healthcare regulations.
Medical Officer - Medi Assist - Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bangalore - 560029
(2019-01 - 2024-12)
- Processed health insurance claims within the defined turnaround time (TAT).
- Reviewed medical records, diagnoses, and treatment details.
- Verified policy terms and supporting documents.
- Approved or rejected claims based on insurance guidelines.
- Raised insufficiency requests (IR) whenever required.
- Ensured compliance with company policies and quality standards.
Claim Adjudicator - UTI Infrastructure Technology & Services Ltd.
(2017-01 - 2018-12)
- Evaluated health insurance claims.
- Verified medical documents and policy coverage.
- Processed claims accurately within turnaround time.
- Coordinated with internal teams for claim resolution.
Staff Nurse - Baby Memorial Hospital - Kozhikode, Kerala
(2015-01 - 2016-12)
Clinical Responsibilities
- Delivered direct patient care.
- Administered medications and treatments.
- Assisted with admissions, discharges, and patient transfers.
- Maintained accurate nursing documentation.
- Educated patients and their families.
- Collaborated with multidisciplinary healthcare teams.
- Worked in General Practice and Obstetrics & Gynecology departments.
Education
Bachelor of Science (BSC) Nursing - Nursing - Rajiv Gandhi University of Health Sciences (2021-01 - 2024-12)
General Nursing and Midwifery (GNM) - Nursing - Baby Memorial School of Nursing (2011-01 - 2015-12)
VHSC - JDT Islam HSS (2010-01 - 2011-12)
