Senior Nurse Consultant (Case Manager)

I have close to a decade experience in the BPO industry catering to Health Insurance clients from the United States. In the early years of my employment, I was assigned to handle precertification requests; I was later on promoted as a Regional Case Manager wherein my main task was to do utilization reviews for members residing within the US and the rest of the world. I assess medical appropriateness and necessity of procedures and admission based on medical documents using evidence-based criteria guidelines (MCG/CPB). In order to perform my tasks effectively, a major part of it was to assign CPT, ICD-10, HCPC and J codes to outpatient procedures, Inpatient procedures and medications respectively.