Medical Coder
Mediclinic City Hospital
Total years of experience :11 years, 6 Months
Auditing claims for proper ICD-10, CPT codes before dispatch as per Coding guidelines.
Handing resubmission for DAMAN and THIQA payers.
Analyzing denials and monthly rejections
Giving feedback to Physicians and Dispatch team to avoid future rejections based on denials trending.
Auditing the existing documentation and preparing action plan.
Preparing training modules for Physicians to improve documentations.
Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third party / payers for payment.
Taking regular education sessions on CPT for physicians, receptionist for billing and insurance.
Coordinating with physician and insurance for proper claiming of all procedures and services done by physician.
Previously was handling submission for DAMAN, THIQA and OMAN payers, later moved to resubmission.
Auditing and correction of codes for IP and OP claims.
Performs other duties assigned by HOD.
Medical Coding
Responsible for assigning proper ICD-10, CPT-4 and HCPCS codes for all claims before submission.
Cross verifications of correctness of medical details entered in the system by doctors or by other staff, including medical necessity of the insurance claims
Assisting clinicians to reach highest specific ICD codes
Assisting nurses and insurance staff to get an appropriate CPT code
Claim Submission
Verification of administrative details of insurance claims like card numbers, insurance plans, and approval requirements etc.
Claims count should be cross checked with the statement of account from system prior to generation of claim submission XML file.
Submission of claims XML file for all insurance company in timely fashion in line with claims adjudication rules on HAAD..
I started my career with Ajuba solutions (india) pvt ltd in the year 2012.My experience and proficiency in ICD-9, ICD-10, CPT-4 and HCPCS is very vast and I have the physical and mental capability to file 150 claims a day. Particularly I am very skilled in evaluation and management coding( inpatient/outpatient, physician coding) and denial management coding. My understanding of medical terminologies is an asset which would help me in obtaining the perfect result. Due to my outstanding performance, communication and interpersonal skills I stood out of my team of 20 and I was given many additional responsiblities of auditing and training junior employees.
I am also proficient in the new ICD-10 system where I have successfully completed my bridgefront ICD-10 training course. I have also given the responsibility of training junior employees with regards to ICD-10.
I have proved my ability and talent once again and I am positive that my profile will suit your requirement.