Insurance Coordinator / Medical Coder
Community Medical Center
مجموع سنوات الخبرة :14 years, 9 أشهر
• Performed receptionist and administrative tasks such as welcoming, greeting and assisting patients who comes in the clinic for medical and dental services and treatments, receiving phone calls, answering or referring inquiries.
• Scheduled appointment for patients, maintaining patient files such as records and accounts, processing payments.
• Ensured availability of treatment information by filing and retrieving patient records.
• Performed eligibility check, prior-authorization and approval request for insured patients using the e-claim portal.
• Analyzed and abstracts doctor’s documentation and assigns correct diagnosis codes (ICD-10), Current Procedural
Terminology (CPT) and Current Dental Terminology (CDT) coding.
• Performed billing by assigning proper and correct prices for the medical and dental treatments obtained by the
patients based on the standard clinic prices and on the agreed tariff prices from the insurance companies.
• Performed eligibility checking, obtains prior authorization request, submission and resubmission of claims.
• Initiated follow-up on pending claim payments that exceeded timeframe from insurance companies through emails
and phone calls.
• Helped and supported Community Medical Center for empanelment application from different insurance
companies. Currently added one (1) insurance company on the network list, added two (2) lower networks and
empaneled additional dental codes.
• Achieved remittance payment backlogs from insurance companies by 92% for FY 2021; 89% 2021 YTD remittance
payments, 11% pending payments and 2.10% rejection payment for FY 2021 as of February 2021.
• Performed receptionist and administrative tasks such as welcoming, greeting and assisting patients who comes in the clinic for dental services and treatments, receiving phone calls, answering or referring inquiries.
• Scheduled appointment for patients, maintaining patient files such as records and accounts, processing payments.
• Ensured availability of treatment information by filing and retrieving patient records.
• Performed eligibility check, prior-authorization and approval request for insured patients using the e-claim portal.
• Prepared daily and monthly income reports and submits to the clinic owner.
• Analyzed and abstract doctor’s documentation and assigning correct diagnosis codes (ICD-10) and Current Dental Terminology (CDT) dental coding.
• Performed billing and submission for claims processing within our network insurance companies and does the resubmission for denied claims using the e-claim portal.
• Monitored submitted and resubmitted claims through the DHPO portal and prepares spreadsheet for records and report presentation.
• Initiated follow-up for claims through emails and phone calls with pending payments which exceeded in a given timeframe.
• Performed marketing through social media platform by posting ads through Facebook and Instagram regarding services and treatment offers of the clinic.
• Designed a patient system file using google sheet and on the process of converting old system filing to computer filing.
• Achieved remittance payment backlogs from insurance companies by 90% for FY 2019; 93% YTD remittance payments, 6% pending payments and 0.70% rejection payment for FY 2020 as of February 2021.
• Managed the store through implementation and execution of action plans, delegating tasks and responsibilities to staff and communicating important updates to the owner.
• Performed management tasks such as forecasting orders, daily and weekly sales reports and cash managements.
• Achieved 40%-46% increase in sales in the 4th quarter of 2018 through store innovation by providing and promoting new affordable and quality products.
• Achieved an “A” rating from the Dubai Municipality audit for 2 consecutive years of 2018 and 2019.
• Attended several events on a part-time basis such as party events, cocktail party, mall events, children events party and food truck events which enabled me to travel different parts of the Emirates all across United Arab Emirates.
• Received calls from the providers providing pre-authorization over the phone for members requiring approvals for inpatient and outpatient services such as medical, behavioral or clinical by looking into patient’s insurance coverage, network, eligibility and benefits.
• Extracted and reviewed fax request regarding medical, behavioral and clinical services or benefits of members/patients.
• Placed correct medical codes such as CPT, ICD-10-CM and HCPCS codes for the corresponding services obtained by the patients.
• Handled retro authorization and dealt with the providers, physicians and doctors to ensure that the codes used for the service were correct to ensure claims will be processed on time and accurately.
• Supervised the team which consists of 15 agents during high volume of calls during the busiest time of managers.
• Achieved YTD call quality audit of 99% which helped the team to achieve a collective average score of 98% audit.
• Developed a strategic flow chart to avoid errors for creating medical case that helped the team to increase YTD audit score from 94% going up to 98%.
• Promoted to Category Level II which handled back-office duties which tasks is to read and analyse claim forms and double check the correct medical codes rendered by the providers.
• Promoted twice within 7 years of my service in Starbucks starting from Barista to Shift Supervisor up to Assistant Store Manager.
• Worked with the Store Manager focusing on running the business by implementing and executing action plans, staffing, hiring and recruitment as well learning and development.
• Performed weekly sales and P&L reporting and being submitted to Store Manager to present to the District Mgr.
• Recognized and reinforced individual and team accomplishments by using existing organizational methods.
• Certified Barista Trainer. (Responsible in training new hired baristas).
• Trained and developed partners that produced 3 key leaders in the store team.
• Received several awards such as “Partner of the Quarter” for 7 times and “Service Award”.
• Established, organized and maintained files and student records and school reports.
• Created memos, reports and spreadsheets for presentation and performed administrative duties.
• Accepted, screened and routed telephone calls to the correct department.
• Organized and arranged meeting, workshops and travel for faculty staff and management.
• Designed and layout the school transcript of records which is being utilized until today by the school.