Nilesh Bhamare

Medical Coder @Optum

Pune, IN

Medical Coder (Core Role Focus)*Assigned accurate ICD-10, CPT, and HCPCS codes for diagnoses and procedures across multiple specialties.*Ensured compliance with AAPC, CMS, and payer-specific guidelines, minimizing errors and denials.*Used EHR systems (Epic, Cerner) for reviewing patient charts and completing coding workflows.*Collaborated with clinical staff to clarify documentation, improving coding accuracy and audit outcomes.*Reduced claim denials by 97% through proactive audits and documentation checks.🧾 Medical Record Reviewer (Documentation & Compliance Focus)Performed thorough reviews of patient medical records to validate code assignments and identify discrepancies.*Ensured proper clinical documentation aligned with coding and billing requirements, supporting quality reporting.*Worked with physicians to enhance documentation standards and regulatory adherence.*Participated in internal coding audits and shared findings to improve accuracy and compliance.*Supported HCC risk adjustment by reviewing charts for chronic conditions and hierarchical mapping.Healthcare Data Analyst (Analytical & Reporting Focus)Analyzed coding trends and claim data to identify patterns, denials, and opportunities for process improvement.*Used Excel and basic SQL for data cleaning and validation related to coding productivity and error tracking.*Generated reports on coding accuracy, audit results, and denial metrics, helping improve revenue integrity.*Collaborated with cross-functional teams to support clinical and operational decision-making through data insights.*Stayed updated with US healthcare regulations and payer policies to interpret data in compliance context.