PBPrayas Bam
@karnabahadurbam
Experienced Claims Processor with a strong background in healthcare.
NepalWhat I'm looking for
I am an experienced Claims Processor with over 6 years of success adjudicating U.S.-based medical insurance claims. My tenure at Vudevi Service Pvt Ltd has allowed me to work with esteemed clients such as Claims Eval Inc and Ethos, where I honed my skills in processing high-volume medical claims accurately and efficiently.
My expertise lies in utilizing platforms like CompuVision (CVX) and MACESS, along with a deep understanding of ICD/CPT coding and HIPAA compliance. I am renowned for my accuracy and speed, consistently exceeding performance standards while supporting internal teams and safeguarding data integrity. I am eager to leverage my skills in a growth-oriented organization that values continuous advancement.
Experience
Work history, roles, and key accomplishments
Clinical Data Analyst
Vu Devi Service Pvt. Ltd.
Jun 2019 - Present (6 years 5 months)
Analyzed provider documentation to ensure proper CPT coding and accurately processed high-volume medical claims for U.S. insurance providers using MACESS and CompuVision (CVX) platforms. Applied ICD-10 and CPT coding to ensure correct adjudication and classification, while maintaining full HIPAA compliance and consistently surpassing team targets for turnaround time and quality.
Intern Clinical Pharmacist
Bangalore Baptist Hospital
Feb 2018 - Present (7 years 9 months)
Partnered with physicians to optimize therapeutic regimens and educated patients on medication adherence, diet, and exercise. Conducted dissertation work on a prescription audit and study on drug utilization patterns in an outpatient pharmacy at a tertiary care hospital.
Education
Degrees, certifications, and relevant coursework
Karnataka College of Pharmacy
Doctor of Pharmacy, Pharmacy
Completed a comprehensive Doctor of Pharmacy program, gaining expertise in pharmaceutical sciences and clinical practice. Focused on drug utilization patterns and patient care in a tertiary care hospital setting.
Manmohan Memorial H.S. School
10+2, General Studies
Completed higher secondary education, building a foundational academic background. Studied a broad curriculum to prepare for further university studies.
Saraswati Higher Secondary School
SLC, General Studies
Completed secondary level education, achieving the School Leaving Certificate. Developed fundamental academic skills across various subjects.
Tech stack
Software and tools used professionally
Availability
Location
NepalAuthorized to work in
Job categories
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