Coordinator
Mediclinic Welcare Hospital
Total years of experience :19 years, 2 months
Medical Reconciliation - following up with the payers to close the financial
year, annual recon report, meeting with payers to discuss claim by claim.
* Denial Management - Orientation for newly joined doctors (eclaim work
flow and coding/ Insurance guidelines)
* Analyzing the denied claim and making sure that it is resubmitted
accurately as per denial reason, ensuring that diagnosis and CPT codes
are updated wherever necessary and proper justification and supporting
documents were given.
* Participating in Clinical Documentation Improvement program.
* Case Management - Coordinating with Insurance team and payers to sort
out daily issues at submission and resubmission levels.
* Conducting Internal and External Audits
* Allocating disallowed amounts as per standard procedure.
* Monthly generation of statements from the system
* Maintain database of processed claims.
* Auditing of RCM team on a monthly basis for potential errors and guiding
and coordinating with submission and resubmission team to reduce these
errors from coding and technical point
* Understanding DHPO schema and sorting out uploading errors
* Actively involved in Utilization review committee. Monthly meeting with
insurance, billing team, doctors to control medical and technical errors.
* Problem Solving and Decision Making for Dispatch/resubmission and Billing
* Staff training
* Input during performance management process.
* Participation in Quality Improvement projects.
Medical Reconciliation and Resubmission
* Internal Medical Pre-approvals.
* Participating in external Audits
* Training Doctors and nurses about Insurance protocols and work flow.
* Coordinating with staff to dispatch bills within stipulated period to
insurance companies.
* Instrumental in reducing rejections and recovery by the Insurance
companies and facilitating training to billing & physicians on intricacies of
insurance submissions, codes, non-covered diagnosis and procedures to
minimize claim rejections
* Checking and verifying Out-patient/In-patient bills prior to submission
* Training front office staff
as a dentist at a dental clinic named Dental Studio
* Dental Treatment in Operative, Periodontics, Endodontics and surgical
procedures.
* Clinic Administration.
* Community trips i.e. School & College visits and presentations.
* Procedures i.e. Scaling and Polishing, Tooth Filling, Single rooted root canal
treatment, Extractions.
* Managing Marketing policies of the clinic.
* Managing Patient data base.
* Patient education and follow up.
* Managing Accounts of the clinic.
in Periodontics, Diagnosis, Operative, Orthodontics, Prosthetic and
Oral Surgery.
* 1 year internship as a dentist
courses: 2018 Preparing for CPC Exam In-house Coding Training Al-Zahra Hospital Sharjah (Al Talouq Coding Institute) Sept 2014
in