Insurance &Adminstrative Incharge

• Apr 2022 - Present

Senior medical coder and claims auditor

• Apr 2018 - Present

Senior Medical coder

• Apr 2018 - Aug 2022

Insurance incharge/ certified medical coder

• Jan 2015 - Feb 2018

Analyzing patient records and assigning correct CPT, CDT, Drug and ICD 10 CM codes. Following coding rule as perh DHA/HAAD and WHO Guideline, Checking medical necessity and necessary for respective procedures as per national correct coding initiative ( NCCI ) Working with remittance advice and giving medical justification for the same to be get paid by re submission. Giving coding education to the doctors regarding guidelines and medical necessity (cover-able diagnosis) based on denials/ Remittance advice. Checking pre-approval and Assisting team to take online pre- approval request. Co-coordinating with insurance company regarding rejection , Payment followup and approval related issues. Addition / deletion of new services. Coordinating with insurance company and making empanelment after price negotiation. Making payer wise monthly revenue and payment details to the management by using PPT and Microsoft office. ( Both submission and Resubmission detail ) Having knowledge about CEED (Coding edit engine Dubai) – For medical necessity and coding edit. Having good knowledge about Eclaim submission and resubmission ( DHPO Portal ) – and dealing with major payer like Daman, Nextcare , ALCO, MEDNET, Neuron etc. Show less

Senior medical coder

• Jan 2014 - Jun 2014

Worked at FPG Healthcare (Chennai) as E &M (out Patient/ observation ), ER , Radiology coding ( Diagnostic ( X-rays, CT’s, MRI, Ultrasound, Nuclear medicine studies ) and interventional radiology ( Cath procedures and biopsy ) , Denial management ( Checking insurance details and medical necessity as per local coverage determination )ICD 10 CM Physician documentation -Senior Medical Coder. Worked at FPG Healthcare (Chennai) as E &M (out Patient/ observation ), ER , Radiology coding ( Diagnostic ( X-rays, CT’s, MRI, Ultrasound, Nuclear medicine studies ) and interventional radiology ( Cath procedures and biopsy ) , Denial management ( Checking insurance details and medical necessity as per local coverage determination )ICD 10 CM Physician documentation -Senior Medical Coder.

Senior Medical coder

• Jul 2012 - Jul 2013

Responsible for translating healthcare providers’ diagnostic and procedural phrases into coded form by reviewing and analyzing health records to identify relevant diagnoses and procedures for distinct patient encounters. Understanding of the health record’s content in order to find information to support or provide specificity for coding. Responsible for translating healthcare providers’ diagnostic and procedural phrases into coded form by reviewing and analyzing health records to identify relevant diagnoses and procedures for distinct patient encounters. Understanding of the health record’s content in order to find information to support or provide specificity for coding.

Medical coder

• Dec 2009 - Jan 2012

Started my carrier in medical coding as coding trainee. Gained in-depth knowledge of coding techniques and guidelines of medical coding. Knowledge of disease processes and procedural techniques to consistently apply the correct codes.Imparting knowledge & assistance to the team whenever deemed necessary, thus playing an important role in team building Auditing of medical codes (CPT, ICD 9, HCPCS) coded by team. Proactively involved in checking the quality, sending daily, weekly & monthly productivity reports Show less