Dr .Nikitha Mandapaka S S S
Hyderabad ,India
Summary
Dynamic professional leveraging a strong foundation in physiotherapy and clinical investigation, particularly with Optum, to excel in assessing claims and identifying fraudulent activities. Expertise includes in-depth knowledge of CPT/diagnosis coding and a proven ability to enhance communication efforts, resulting in improved claim processing efficiency and accuracy while maintaining compliance with medical and insurance regulations.
Overview
3
3
years of professional experience
Work history
Clinical Investigator
Optum
Hyderabad , India
06 2023 - Current
Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guidelines, along with referring to client-specific guidelines and member policies.
Physiotherapist
Ankura hospital, women and children
Hyderabad
12 2022 - 05 2023
- Educator of Child Birth
- Lactation consultant
- Certified women health and personal counsellor
- Gyenic physiotherapist
Physiotherapist
C C SHROFF MEMORIAL HOSPITAL
Hyderabad
2021.09 - 2022.09
Physiotherapist
Zenowalk physiotherapy
12 2020 - 08 2021
Education
Bachelor of Physiotherapy - Physiotherapy
Nizam institute of medical sciences (NIMS)
09/2015 - 10/2020
undefined
NIMS
Intermediate - BIPC
Sri Gayatri junior College
06/2013 - 05/2015
School -
SRI krishnaveni talent school
Skills
- Ability to review and assess detailed information from claims, including policy documents, medical reports, and accident reports
- Familiarity with terms, conditions, exclusions, and coverage limits to determine policy applicability
- Ability to identify fraud, errors, or omissions in claim submissions
- Understanding of federal and state insurance regulations, including fraud detection laws, claims handling procedures, and privacy protections (eg, HIPAA)
- Ability to ensure all claims are processed in accordance with legal requirements and company standards
Additional Information
- PUBLICATIONS Published a blog on bells palsy Published blog on lactation
Timeline
Physiotherapist
C C SHROFF MEMORIAL HOSPITAL
2021.09 - 2022.09
Clinical Investigator
Optum
06 2023 - Current
Physiotherapist
Ankura hospital, women and children
12 2022 - 05 2023
Physiotherapist
Zenowalk physiotherapy
12 2020 - 08 2021
Bachelor of Physiotherapy - Physiotherapy
Nizam institute of medical sciences (NIMS)
09/2015 - 10/2020
undefined
NIMS
Intermediate - BIPC
Sri Gayatri junior College
06/2013 - 05/2015
School -
SRI krishnaveni talent school