Niharika Mangalarapu
Analyst @R1 RCM
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WORK HISTORY
Analyst @R1 RCM
Hyderabad, IN
Responsible for evaluating and processing prior authorization requests in compliance with US healthcare policies and payer-specific guidelines.Reviewing clinical documentation, verifying patient eligibility, and ensuring timely and accurate approvals or denials for medical procedures, diagnostics, and prescriptions.Collaborating with cross-functional teams including insurance providers to streamline the authorization process, reduce turnaround times, and enhance patient access to essential healthcare services.US Healthcare System & InsurancePrior Authorization & Claims ProcessingClinical Documentation ReviewHIPAA ComplianceMedical TerminologyEMR/EHR SystemsCommunication Skills
EDUCATION
Osmania University, Hyderabad
Bachelor of Pharmacy
Sri Venkateshwara College of pharmacy
Bachelor of Pharmacy - BPharm
ABOUT NIHARIKA MANGALARAPU
I am a registered pharmacist under Telangana state pharmacy council with bachelor of pharmacy degree from Sri Venkateshwara College of Pharmacy, Madhapur, affiliated to Osmania University. I am currently working with R1 RCM in Prior authorization department as an Analyst, where IReviewed and initiated prior authorization requests using web portals such as UHC, Carelon, Cohere, Availity, and eviCore, ensuring compliance with payer-specific requirements and clinical criteria.· Accurately submitted clinical documentation using EPIC systems, coding procedures with appropriate CPT and ICD-10 codes to support medical necessity and avoid delays or denials.· Verified patient eligibility and benefits through insurance portals and direct payer calls, confirming plan coverage, authorization requirements, and benefit limits.· Proactively followed up on pending or denied authorizations by communicating with payers, maintained strict adherence to HIPAA guidelines.In academics, I have learned about drug discovery and development, formulation and evaluation of various drugs, their pharmacology, chemistry, adverse effects. I have strong foundation of role of different departments like Research and Development, Quality Assurance, Quality Control and involvement of regulatory requirements, pharmacovigilance in formulation of single drug.I have done two projects in college which were \" Quality Assessment of cold compressed edible oils\",\"Development of dental gels for stain removal\" which allowed me to enhance my knowledge on industry processes for formulation and evaluation. I had the opportunity to publish my research work on \"Formulation and evaluation of plants based mosquito repellent candles\" as a main author in JETIR August 2024. I have contributed as an intern at Campalin innovations to Green synthesis of nano metal particles project for the treatment of microbial infections.Through various online platforms I honed skills in such as Clinical research, clinical data management, pharmacovigilance, Drug discovery and development processes, Market research, genetic sciences.I am eager to contribute to innovative projects and initiatives in pharmaceutical industry. As a dedicated learner,I am committed to staying a head of the latest advancements in pharmacy field and leveraging my skills to make meaningful contributions to the field. Seeking opportunities to collaborate with pharmacy professionals and gain hands on experience to further develop my expertise. Let\'s connect and explore ways to make a positive impact in health care together.
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