Dr Praveen Ganapathiraju's Profile
Dr Praveen Ganapathiraju | |
Quality Analyst, United Health Care India (UHCI), a UHG(United Health Group Company). | |
 | United Health Care India (UHCI), a UHG(United Health Group Company.  |
Professional summary
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Current Experience:
Quality Analyst, United Health Care India (UHCI), a UHG(United Health Group Company.
Previous: Lead Quality Analyst, My
Medical Officer & HOD Pre Authorization, Medical Officer
Heritage Health TPA PVT LTD
Medical Officer, While
Medical Officer, While
Medical Officer, -
Medical Officer, -
Heritage Health TPA PVT LTD
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4.0 Years
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WORKING IN INSURANCE SECTOR AS A QUALITY ANALYST AND WORKED PREVIOUSLY AS A MEDICAL OFFICER IN INSUR ...
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2 recommendations
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Contribution score:(133 points)
- Contacts: 56 connections, 57 following, 54 followers
Dr Praveen Ganapathiraju's Experience
| Current : |
Quality Analyst, United Health Care India (UHCI), a UHG(United Health Group Company. |
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| Insurance | ||
Working from 2010 | ||
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Brief summary :
Working as a Quality Analyst in validating Life insurance claims & deal with the grievances rasied by the Insurers & will resove the same in stipulated TAT.Deal even with the escalations raisaed from Insurers & clients & managing them in timely manner.
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| Previous : |
Lead Quality Analyst, My |
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Worked from 2010 to 2012 | ||
Brief summary :
United Health Care (under UHG, Fortune 1st ranking) - Lead Quality Analyst - May `10 - Till Date. My key responsibilities are: Managing QA team and maintain 100% accuracy in delivering information to UHCs clients that are primarily Insurance organizations. Maintain quicker TAT (Turn around Time), in providing reports to clients and authenticating those reports. Scrutinize Pre Insurance Medical reports before they reach out to client and eliminate queries that may cause delay in approval process. Some of the top clients that I work with are: Aegon Religare Bharti AXA MetLife SBI ICICI Lombard Max New York Canara HSBC DLF Pramerica Manage Pre Employment Check ups and provide Fitness statuses to the concerned HR departments of the clients. Some of the clients include top class organizations such as: AXIS Bank Fidelity JP Morgan Financiers Writers corporation LOreal Alcatel Lucent Noetix As a QA Lead, I interact with several Insurers and Doctors at Diagnostic Centers to validate the information, before approving Medical reports within the TAT. Grievance handling - This is another challenging area that I deal with, for a timely closure of grievances, sustaining the relationships stronger with the clients of UHC. Grievances are tracked through QMS tracker and are usually closed within the stipulated TAT of 24 hrs. I also work with the Grievance cell in the organization to review grievances reported to other departments to ensure similar grievances are prevented within my department. This proactive work helps in minimizing the error rate within my department. Providing orientation to Diagnostic Centers regarding Quality aspects of the reports Training QA team in handling issues, dealing with DCs (clients) Providing TAT reports to senior Management in a timely manner with progress updates Work with other internal team heads such as Network team and empanel good DCs that can provide quality service. I also monitor their service and provide feedback to Network team from time to time, suggesting for reorientation of DCs if necessary, in order to maintain quality service Managing scanned copies of reports that are uploaded to the Company website ( Finedocs ) in a timely manner, so that Insurers can download reports for faster closure | ||
| Previous : |
Medical Officer & HOD Pre Authorization, Medical Officer |
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| Medical Devices, Products & Solutions | ||
Worked from 2009 to 2010 | ||
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Brief summary :
Worked as a Medical Officer & Head Of the Department for Pre Authorization of cashless claims. | ||
| Previous : |
Heritage Health TPA PVT LTD |
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Worked from 2009 to 2010 | ||
Brief summary :
Heritage Health TPA PVT LTD from July `09 - April `10. Professional Profile A dynamic professional with nearly 1 year of experience in Claims Processing, Pre Authorization, Client Relationship Management and Documentation. Worked as a Medical Officer - Claims with Heritage Health TPA Ltd. Exposure in managing claims of various product portfolios including visiting the spot of loss, making thorough physical inspection, scrutinizing supporting papers, books of accounts as per the requirement and submitting independent reports. Consummate professional with excellent planning, execution, monitoring and resource balancing skills, attention to detail as well as the ability to build and lead effective teams. Outstanding presentation and leadership skills. Abilities in cementing healthy relationship with the clients for generating business and leading workforce towards accomplishing business and corporate goals. Possess excellent interpersonal and organizational skills with proven abilities in customer relationship management and planning. I will give medical opinions regarding the different claims we receive. I mainly give Pre Authorizations for claims from National Insurance from Hyderabad Branch, United Insurance from Chennai Branch, New India Assurance claims from Vizag branch. I mainly interact with the clients regarding any claims and give the medical opinions regarding the admissibility of the claims whether they are payable or not. I deal with Individual policies from National, United, Oriental, New India Assurance and so many corporate clients like OCV Reinforcements, TATA Projects limited, DST,VST Technologies, Cream line Dairy Products, Rane Engine Valve, AP Tourism(APTDC),AP Mineral Development (APMDC), Flag Stone etc. I give authorizations or repudiations for the Reimbursement claims based on their admissibility according to the terms and conditions of the policies. In National Insurance I will look over different policies like Individual Medi Claim Policy Family Parivar Policy Varishta Policy for the elderly people Personal Accident Policy Universal policy In United I deal with different Policies like United Platinum Policy for the youngsters United Gold Policy for the Middle Age People United Senior Citizen Policy for the People aged above 60 yrs. United Family Policy United Individual Medicare Policy. In New India Assurance I mainly deal with Individual Policy Janatha Policy I am experienced in coding of different Diseases based on the ICD (International Coding for Diseases) for different claims we receive. I give Medical opinions for different claims regarding the amount payable for a particular claim based on the tariff for the different procedures for the different ailments. I will be enthusiastic to know the latest advancements in the Medical field and what are the new techniques and Treatment procedures that will be adopted by different hospitals for different ailments and the cost of the procedures and their indication in which kind of ailments. Pavan Sai Orthopedic Hospital - Medical Officer - Feb 09 - June `09 In this multi specialty orthopedic hospital, I have dealt with a variety of orthopedic cases and treated those using necessary operating procedures in some cases, by using even C-ARM. I attended different types of orthopedic cases such as, Inter vertebral Disc Prolapse, age related Osteoarthritis, Osteoporosis in elderly women, Tendinitis, Bursitis, Ankylosing spondilitis, spondylolisthesis. Analyzed the cases and was able to differentiate which cases need to be medically managed and which of them needed surgical intervention. | ||
| Previous : |
Medical Officer, While |
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Worked from 2007 to 2008 | ||
Brief summary :
K G H Urology Hospital - Medical Officer - Nov 07-Dec `08 While working in this super specialty Urology hospital, I handled medical issues with Urino-Genital conditions and managed them medically or surgically, as needed. During this tenure, I had an opportunity to analyze several Male uro genital conditions and Urinary Tract Infections like Urethritis, CystitisEpidydimitis, Prostatis, Renal calculi,Benign Prostatic Hypertrophy, Phymosis, Para phymosis, Epi spadiasis, Hypo Spadiasis etc. And female Uro Genital conditions such as Cervicitis, Vulvitis, Endometritis, Vaginitis etc. I handled Urological emergencies with Acute or Chronic Renal Failure, Acute Glomerulo Nephritis, Hydro nephrosis, TB of Kidney, Diabetic Nephropathy etc. | ||
| Previous : |
Medical Officer, While |
|
Worked from 2007 to 2008 | ||
Brief summary :
K G H Urology Hospital - Medical Officer - Nov 07-Dec `08 While working in this super specialty Urology hospital, I handled medical issues with Urino-Genital conditions and managed them medically or surgically, as needed. During this tenure, I had an opportunity to analyze several Male uro genital conditions and Urinary Tract Infections like Urethritis, CystitisEpidydimitis, Prostatis, Renal calculi,Benign Prostatic Hypertrophy, Phymosis, Para phymosis, Epi spadiasis, Hypo Spadiasis etc. And female Uro Genital conditions such as Cervicitis, Vulvitis, Endometritis, and Vaginitis etc. I handled Urological emergencies with Acute or Chronic Renal Failure, Acute Glomerulo Nephritis, Hydro nephrosis, TB of Kidney, Diabetic Nephropathy etc. | ||
| Previous : |
Medical Officer, - |
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Worked from 2007 to 2007 | ||
Brief summary :
Sai Nikith Hospital - Medical Officer - Feb `07 - Oct `07 I worked for a senior Surgeon and analyzed a wide variety of surgical cases and participated in surgical procedures. Identifying the need for surgical intervention for cases with Acute Appendicitis, Acute Cholecystitis, Acute Intestinal Obstruction, Ectopic Pregnancy, Cholelithiasis, Renal Calculus etc. And some of the cases with elective surgeries such as, Heamorrhoids, Fistula in Ano, Fissure in Ano,Cataract, Bening Prostatic Hypertrophy, Hernia, Circumcession, Hydrocele, Hysterectomy, LSCS, Tonsils, Adenoids, Deviated Nasal Septum etc. Dharma Kiran Government Hospital - Junior Resident - Dec 07 - Dec `08 My experience includes treating medical cases with Chronic Bronchitis, Alcoholic Cirrhosis of Liver, Muscular Dystrophy, Eczematous eruptions of Skin, Rheumatic Arthritis, and Chronic Follicular Pharyngitis etc. and surgical cases such as, Varicosity of veins, Benign Prostatic Hypertrophy, Acute Appendicitis, Intestinal Obstruction, Traumatic Inter vertebral Disk Prolapse, Inguinal Hernia etc. Department of Medicine, Psychiatry, and Dermatology and Pediatrics - I treated about 25 acute cases and 15 chronic cases. Also participated in proving/reproving programme. Surgery including ENT and Ophthalmology - As a Junior resident, I assisted a senior Doctor in 14 surgical cases Department of Gynecology and Obstetrics - I worked with a Senior Surgeon for about 10 Normal / Abnormal Deliveries House Physician: During the course of my house physician, I worked under Medicine Department and encountered with several medical cases - Chronic Bronchitis, Alcoholic Cirrhosis of Liver, and Muscular Dystrophy, Eczematous eruptions of Skin, Rheumatic Arthritis, and Chronic Follicular Pharyngitis etc and got acquainted with managing / treating those cases. During my Surgery posting I came across surgical cases such as Varicosity of veins, Benign Prostatic Hypertrophy, Acute Appendicitis, Intestinal Obstruction, Traumatic prolapsed Inter vertebral Disk , Inguinal Hernia etc and learnt to differentiate surgical cases from medical cases and managing them suitably. During my gynecology and Obstetrics posting, I assisted some senior doctors treating normal deliveries with usual occipital presentation, rare presentations like breech and shoulder and Caesarian sections, forceps deliveries etc., and got acquainted with several developmental anomalies during pregnancy. During my community social preventive medicine posting I participated medical camps in Rural Indian villages and slums and actively participated in disease diagnosis, management, Treatment, prognosis of the cases dwelling there and distributed medicines to those in need. Participated in medical campaigns for educating rural people and providing awareness on the commonly caused infectious diseases. Articles: Efficacy of Homoeopathy in the treatment of Diabetes Mellitus: A Clinical Study - I wrote this article for our college souvenir released in 2007, in which I discussed about the Definition, Classification, Types, Occurrence, Signs and Symptoms, Complications, Diet and Regimen to follow, Management and Homoeopathic Treatment of Diabetes. Nano Medicine - During the course of my Nano Sensitization Program, I authored this article on Nano Technology related to medicine wherein I discussed about how to get over cancer by using latest advancements in Nano Technology. In our experiments, we designed a small device to identify and kill cancer cells. The device would have a small computer, several binding sites to determine the concentration of specific molecules, and supply of some poison which could be selectively released to kill the cell identified as cancerous By using several macroscopic acoustic signal sources, the cancer killer could determine its location within the body much as a radio receiver on earth can use the transmissions from several satellites to determine its position (as in the widely used GPS system). | ||
| Previous : |
Medical Officer, - |
|
Worked from 2007 to 2007 | ||
Brief summary :
Sai Nikith Hospital - Medical Officer - Feb `07 - Oct `07 I worked for a senior Surgeon and analyzed a wide variety of surgical cases and participated in surgical procedures. Identifying the need for surgical intervention for cases with Acute Appendicitis, Acute Cholecystitis, Acute Intestinal Obstruction, Ectopic Pregnancy, Cholelithiasis, Renal Calculus etc. And some of the cases with elective surgeries such as, Heamorrhoids, Fistula in Ano, Fissure in Ano,Cataract, Bening Prostatic Hypertrophy, Hernia, Circumcession, Hydrocele, Hysterectomy, LSCS, Tonsils, Adenoids, Deviated Nasal Septum etc. Dharma Kiran Government Hospital - Junior Resident - Dec 07 - Dec `08 My experience includes treating medical cases with Chronic Bronchitis, Alcoholic Cirrhosis of Liver, Muscular Dystrophy, Eczematous eruptions of Skin, Rheumatic Arthritis, and Chronic Follicular Pharyngitis etc. and surgical cases such as, Varicosity of veins, Benign Prostatic Hypertrophy, Acute Appendicitis, Intestinal Obstruction, Traumatic Inter vertebral Disk Prolapse, Inguinal Hernia etc. Department of Medicine, Psychiatry, and Dermatology and Pediatrics - I treated about 25 acute cases and 15 chronic cases. Also participated in proving/reproving programme. Surgery including ENT and Ophthalmology - As a Junior resident, I assisted a senior Doctor in 14 surgical cases Department of Gynecology and Obstetrics - I worked with a Senior Surgeon for about 10 Normal / Abnormal Deliveries House Physician: During the course of my house physician, I worked under Medicine Department and encountered with several medical cases - Chronic Bronchitis, Alcoholic Cirrhosis of Liver, and Muscular Dystrophy, Eczematous eruptions of Skin, Rheumatic Arthritis, and Chronic Follicular Pharyngitis etc and got acquainted with managing / treating those cases. During my Surgery posting I came across surgical cases such as Varicosity of veins, Benign Prostatic Hypertrophy, Acute Appendicitis, Intestinal Obstruction, Traumatic prolapsed Inter vertebral Disk , Inguinal Hernia etc and learnt to differentiate surgical cases from medical cases and managing them suitably. During my gynecology and Obstetrics posting, I assisted some senior doctors treating normal deliveries with usual occipital presentation, rare presentations like breech and shoulder and Caesarian sections, forceps deliveries etc., and got acquainted with several developmental anomalies during pregnancy. During my community social preventive medicine posting I participated medical camps in Rural Indian villages and slums and actively participated in disease diagnosis, management, Treatment, prognosis of the cases dwelling there and distributed medicines to those in need. Participated in medical campaigns for educating rural people and providing awareness on the commonly caused infectious diseases. Articles: Efficacy of Homoeopathy in the treatment of Diabetes Mellitus: A Clinical Study - I wrote this article for our college souvenir released in 2007, in which I discussed about the Definition, Classification, Types, Occurrence, Signs and Symptoms, Complications, Diet and Regimen to follow, Management and Homoeopathic Treatment of Diabetes. Nano Medicine - During the course of my Nano Sensitization Program, I authored this article on Nano Technology related to medicine wherein I discussed about how to get over cancer by using latest advancements in Nano Technology. In our experiments, we designed a small device to identify and kill cancer cells. The device would have a small computer, several binding sites to determine the concentration of specific molecules, and supply of some poison which could be selectively released to kill the cell identified as cancerous By using several macroscopic acoustic signal sources, the cancer killer could determine its location within the body much as a radio receiver on earth can use the transmissions from several satellites to determine its position (as in the widely used GPS system). | ||
| Previous : |
Heritage Health TPA PVT LTD |
|
Brief summary :
Heritage Health TPA PVT LTD from July-2009 - Till Date. Professional Profile A dynamic professional with nearly 1 year of experience in Claims Processing, Pre Authorization, Client Relationship Management and Documentation. Working as a Medical Officer - Claims with Heritage Health TPA Ltd. Exposure in managing claims of various product portfolios including visiting the spot of loss, making thorough physical inspection, scrutinizing supporting papers, books of accounts as per the requirement and submitting independent reports. Consummate professional with excellent planning, execution, monitoring and resource balancing skills, attention to detail as well as the ability to build and lead effective teams. Outstanding presentation and leadership skills. Abilities in cementing healthy relationship with the clients for generating business and leading workforce towards accomplishing business and corporate goals. Possess excellent interpersonal and organizational skills with proven abilities in customer relationship management and planning. I will give medical opinions regarding the different claims we receive. I mainly give Pre Authorizations for claims from National Insurance from Hyderabad Branch, United Insurance from Chennai Branch, New India Assurance claims from Vizag branch. I mainly interact with the clients regarding any claims and give the medical opinions regarding the admissibility of the claims whether they are payable or not. I deal with Individual policies from National, United, Oriental, New India Assurance and so many corporate clients like OCV Reinforcements, TATA Projects limited, DST,VST Technologies, Cream line Dairy Products, Rane Engine Valve, AP Tourism(APTDC),AP Mineral Development (APMDC), Flag Stone etc. I give authorizations or repudiations for the Reimbursement claims based on their admissibility according to the terms and conditions of the policies. In National Insurance I will look over different policies like Individual Medi Claim Policy Family Parivar Policy Varishta Policy for the elderly people Personal Accident Policy Universal policy In United I deal with different Policies like United Platinum Policy for the youngsters United Gold Policy for the Middle Age People United Senior Citizen Policy for the People aged above 60 yrs. United Family Policy United Individual Medicare Policy. In New India Assurance I mainly deal with Individual Policy Janatha Policy I am experienced in coding of different Diseases based on the ICD (International Coding for Diseases) for different claims we receive. I give Medical opinions for different claims regarding the amount payable for a particular claim based on the tariff for the different procedures for the different ailments. I will be enthusiastic to know the latest advancements in the Medical field and what are the new techniques and Treatment procedures that will be adopted by different hospitals for different ailments and the cost of the procedures and their indication in which kind of ailments. Pavan Sai Orthopedic Hospital - Medical Officer - Feb 09 - June `09 In this multi specialty orthopedic hospital, I have dealt with a variety of orthopedic cases and treated those using necessary operating procedures in some cases, by using even C-ARM. I attended different types of orthopedic cases such as, Inter vertebral Disc Prolapse, age related Osteoarthritis, Osteoporosis in elderly women, Tendinitis,Bursitis, Ankylosing spondilitis, spondylolisthesis. Analyzed the cases and was able to differentiate which cases need to be medically managed and which of them needed surgical intervention. | ||
| Recommendation |
Dr.Ganapathiraju represents a good hearted, passionate and hard working professional. He is keen to excel and i wish him all success.
I have been introduced to Dr Praveen Ganapathiraju through toostep.com. Dr Praveen has a wide knowledge of different topics and feels free to share his thoughts and knowledge with everyone. His articles and views posted on toostep.com are very informative and up-to-date. I wish him the very best in everything.
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Avoid Fats,Spices and Oils |
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