CURRICULAM VITAE

Dr.J.Jemimah Crescentia

Mobile: 050-*******

Mail Id: actikt@r.postjobfree.com

AAPC Member ID: 01090415

CPC, CPMA, ICD10 Certified-AAPC

Aiming to grow high in the field of Health Information Management (Coding, Auditing, Documentation, Physician Education & Training, Denial Management, Reconciliation, etc by effectively applying adequate skills and knowledge adhering to the system to execute professionalism in all work related areas. Extensive knowledge in Evaluation management (E&M) and ER. Developed 360 degree of knowledge & understanding in all extents of coding which includes procedural coding, Surgery, Radiology & Interventional Radiology (IVR), Pathology, HCPCS etc.

Private medical center in Abudhabi, L.L.C Feb 2013 to till date Medical Coding Auditor

Alwathba National Insurance Company, P.S.C, Abudhabi Dec 2011 to Feb 2013

(On shore project - Representing Caliber Point in Abu Dhabi, UAE) Insurance Specialist (Medical Claims & Coding Auditor)

Medusind Solutions India Pvt Ltd. Chennai. March 2007 to Dec 2011 Senior Medical Analyst

Objective

Brief Overview

Total Professional Experience 10 years which includes 8 years in Medical Coding & Auditing

& AUDITING

Roles and Responsibilities: Private Medical Center, Abu Dhabi - UAE

Working as “Auditor-Medical Coding” at abudhabi’s one of the best and familiar medical center with about 40 physician from different specialties like pediatric, gynecology, cardiology, pulmonology, gastroenterology, ENT, Orthopedics, dermatology, ophthalmology, urology, endocrinology, dental, neurology, general surgery, physiotherapy, radiology, pathology etc.,

Completely managing all coding and audit related issues,

Assisting physicians and nurses in finding out and assigning appropriate procedural codes and medical necessities,

Educating and training physicians on appropriate documentations, various fields of coding such as Evaluation and Management coding, procedural coding, diagnostic coding etc.,

Assisting the Insurance Manager in the departmental orientation and training of newly hired Coding assistance/medical secretaries, nurses and physicians.

Handling all rejections and insurance related issues with utmost proficiency and thus able to minimized the rejection rates from 10% to 3%

Conducing internal audits on monthly basis to maintain accuracy & quality of coding and providing with customized audit report every month

Conducting regular yearly HAAD coding audit and thus maintaining current facility’s Coding license

Providing feedbacks to physicians on documentations & coding based on audit reports and also suggestions given to avoid future rejections

Being a platform to all the coding, healthcare and HAAD updates in the medical center, finds out all possible ways for re-imbursement and pending payments

Answering all queries regarding pre-authorization and re-submission process, handling & correcting pre-authorizations denials

Assisting the management in sending all professional communications with the payers with highest accuracy. Analyzing and implementing the appropriate suggestions and solutions in all payment related issues and initiating on routine follow-up of all pending claims & reimbursement

Being a single point of contact for all coding related queries with good knowledge of all payer’s strategies and coverage limitations, CCI edits and bundled codes.

Added knowledge of Green rain messenger on remittance advice & resubmissions

Efficient in usage of all US & UAE based coding software Roles and Responsibilities: Alwathba National Insurance PSC, Abu Dhabi - UAE

Managing an Audit project individually in Abu Dhabi, UAE.

Medical claims auditing on behalf of the payer.

To minimize the financial loss to payers by auditing process.

Identifying the provider’s and TPA’s medical claim errors especially in coding and related areas and checking for claims approval & denials,

Providing feedbacks and solutions to eradicate these claim errors or denials to TPAs and providers,

For claims exceeding the acceptable AED limit, a check was done for the necessary approval from the payer,

Checking and identifying the duplicate claims,

Validating the encoded information as whether it is reported in the most accurate information

Verifying the medical necessity & need for the procedures done,

Generating weekly and monthly audit finding reports and updating the clients.

Training the off shore employees according to the client’s requirement.

Maintaining all logs related to productivity, work allocation, and job description etc.

Capable of training team members and associates, mostly doctors

Developing multiple channel of communication to both providers and payers – Audit process and feedbacks,

Identifying all the possible reasons for claim denial through internal & external audit and suggesting the ways to minimize AED loss,

Proven leadership quality by obtaining and achieving 360 degree level of operation and adding value to the organization associated with.

Roles and Responsibilities: Medusind Solutions Pvt Limited, Chennai - India

Individual project management.

Doing Emergency room (ER) and Evaluation and Management (E/M) QA and maintaining quality.

Reviewing & assigning appropriate E&M’s codes based on Clinical documentation available in medical records, to ensure proper re-imbursement for the facility

Ensuring accurate coding and sequencing as specified by the basic coding guidelines & rules

Reviewing & confirmation of assigned codes for resubmissions & denials for re- imbursement needs, pertaining to coding error

Ensure to achieve daily targets.

Was working on Pilot projects in Specialty like ER, Urgent Care Center and Acute Care Center.

Adequate work experience in denial projects and insurance reimbursements with appropriate coding & medical records.

Handling of client requirement and planning work execution.

Maintaining all logs related to productivity, work allocation, and job description etc.

Capable of training team members and associates.

Client communication (Includes direct contact with client through call for coding & billing clarifications, physician feedbacks & education)

Attending client calls for new projects and learning the process and client expectations

Reporting to Team Leader.

Domain Knowledge:

Expertise in Surgery, Evaluation and Management especially outpatient, inpatient & procedural coding, Medicine, Surgery, Radiology, Pathology, HCPCS, ICD-9 & ICD-10 CM diagnosis and Medicare & HAAD guidelines.

Anatomy, Physiology, Bio-chemistry, Pathology & Gynecology knowledge as per the medicine degree syllabus of physician

Medical terminology knowledge

Medical coding & auditing knowledge.

MS Office and computer proficiency

HIPAA knowledge.

Adaptable to team work

Quality management.

Good listener and quick learner.

Achievements:

Passed CPC (Certified Professional Coder) exam in May 2007 & CPMA (Certified Professional Medical Auditor) in Dec 2014 conducted by AAPC - American Academy of Professional Coders.

Worked in various pilots projects for US and UAE

Participated coding seminars conducted by AAPC.

Stays current with the clinical coding system by attending various coding workshops, seminars, publications, CEUs & insurance updates

Attended all the coding seminars organized by Coding Steering Committee of Health Authority Of Abu Dhabi ( HAAD )

Good understanding of HAAD claims adjudication rules & regulations

Attended the annual HIM (Health Information Management) National Congress in Abu Dhabi, thus have good knowledge in RCM and HIS areas

Payers-Provider denial management and reduction of the rejection rate

Additionally obtained knowledge in ICD-10-CM, ICD-10-PCS & DRG coding and auditing.

Evaluated & awarded as team of the quarter for playing vital role in clearing client huge backlogs with in the stipulated period.

Good knowledge on HAAD standards for Payers & Providers

Conducted coding audit in American Hospital, Dubai & provided the graphical representations and various suggestions to improve the quality of coding Personal Skills:

Comprehensive problem-solving abilities

Excellent verbal and written communication skills

Ability to deal with people diplomatically

Willingness to learn

Team worker with great communication skills

Flexible, assertive and adaptable.

GOD fearing, sincere & hard working

Added Values:

Being a doctor, clearly understands all the medical aspects of coding and easily intractable with doctors,

Have work experience and knowledge of coding and insurance aspects from both sides(Payers and Providers)

Efficient in handling auditing and coding processes individually due to prior experiences,

Being a experienced person able to handle situations and make correct decisions without interference or assistance,

Strives hard to maintain professionalism in all aspects of work,

Adjustable and eager to learn new things and easily approachable Clinical Experience:

*Billroth Multispecialty Hospitals, Chennai.

Duty Medical Officer Feb 2006 to Feb 2007

Roles and Responsibilities:

Taking care of the patients in the floor allotted by conducting regular rounds and informing patient’s status to respective consultants,

Pre-operative care such as preparation of patient for surgery, i.e. from collecting history, conducting physical examinations with pre-operative screening and documenting, making decisions on the patient’s fitness for surgery and proper intimation to surgeons and anesthesiologist,

Post-operative cares for surgical patients such as catheter removal, drainage tube removal, suture removal, change of wound dressing etc..,

Performing ward procedures of GJ tube, NG tube removal, PICC line removal, etc..,

Taking care of regular dialysis patient as checking the status of AV shut, regular monitoring of BP, Pulse, Temperature etc..,

Taking care of the emergency room and ICU, CCU patients as and when required,

Conducting and assisting the emergency room procedures such as suture repair, paracentesis, Incision & Drainages, NG tube placement, Foley catheter placement etc… A.L.A Memorial Nursing Home, Tenkasi, TN Sep 2004 to Oct 2005 Residential Medical Officer

Roles and Responsibilities:

Conducing daily rounds for post-operative & general wards and providing patient care & counseling on suture removal, dressing, drainage removal etc…,

Assisting and Providing consultations for the Outpatients(Obstetrics, Non-Obstetrics & Pediatric)

Providing antenatal, postnatal and neonatal care and counseling,

Assisting in conducting normal & caesarian deliveries and pediatric procedures and vaccinations.

Qualificat ion and knowledge

Master degree in Medical Sociology (MSc) from the University of Madras, India

Bachelor degree in Siddha(Indian) Medicine and Surgery(BSMS) from Government Siddha Medical College, Palayamkottai, Tamil Nadu, India

Higher Secondary or 12th education from A.V.Rm.V.Matriculation Higher Secondary School, Tamilnadu, India

Matriculation or 10th education from A.V.Rm.V.Matriculation Higher Secondary School, Tamilnadu, India

Excellent and Certified in MS office usage

Coding Certification

Certified Professional Coder(CPC) certification from American Association Of Professional Coders(AAPC) in May 2007

ICD-10 certification from AAPC

Auditing Certification

Certified Professional Medical Auditor(CPMA) certification from American Association Of Professional Coders(AAPC) on December 2014 BLS Certification

Basic Life Support(BLS) Certification – Uniteam Medical Assistance(AHA approved) – Valid till March 2017

Post-Graduation in Medical Sociology - MSc from University Of Madras ( 2009 - 2011 ) with a first class with more than 75 percentage.

BSMS(Bachelor of Siddha Medicine & Surgery) from Government Siddha Medical College Palayamkottai from MGR Medical University(1998 –2004)

College Topper in Fourth & Final Year Examinations.

Achieved First Class With 71.60% in BSMS.

Internship from Medical College Hospital Palayamkottai, TamilNadu, India

School Topper in Higher Secondary Examinations.

91.25% in Higher Secondary Examinations. (1997 – 1998)

86.54% in Matriculation Examinations. (1995-1996) ACADEMIC ACHIEVEMENTS

PERSONAL INFORMATION

Name : J.Jemimah Crescentia.

Husband Name : J.P.Victor Jabaraj.

Gender : Female.

Language Proficiency : English (R/W), Tamil (R/W), Hindi (R/U), Passport Status : Active (G1239058)

Visa Status : Resident - Active

Current Address : No.202, 2th Floor, Tigris Valley Building, Hamdan street, Abudhabi

Abu Dhabi, UAE.

Declaration

I hereby declare that the information given above is true to the best of my knowledge. DATE : Nov 26 - 2015

PLACE : Abu Dhabi (Dr.J.Jemimah Crescentia)

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