Medical claims Auditor with 6yrs experience in medical coding&auditing

CURRICULAM VITAE

Dr.J.Jemimah Crescentia No.***, 9th Floor, Kwality Restaurant

Building, Hamdan St,

P.O. Box : 26550,

Abu Dhabi

United Arab Emirates

Mobile: 050-

6824532

Mail Id: *********@*****.**.**

AAPC Member ID: 01090415

Aiming to grow high in the field of medical coding and auditing by

developing adequate skills and knowledge to execute professionalism in all

work related areas.

Working for a Private Insurance in Abu Dhabi, UAE as an Insurance Auditor

with CPC Certification.(Certified Professional Coder )

. Caliber Point Business Solutions India Pvt Ltd. Chennai. Dec 2011

to till date

(On shore project - Representing Caliber Point in Abu Dhabi, UAE)

Senior Insurance Specialist Dec 2011 to till date

. Medusind Solutions India Pvt Ltd. Chennai. March

2007 to Dec 2011

Senior Medical Analyst June 2008 to Dec 2011

Medical Analyst March 2007 to May 2008

On my entry into Medusind Solutions, underwent extensive training in

Evaluation management (E&M) especially ER for 6 months & started working on

live projects. Meanwhile additionally trained for other areas of coding

which includes procedural coding, Surgery, Interventional Radiology (IVR),

Pathology, Radiology, HCPCS, etc..,

Roles and Responsibilities: Caliber Point Business Solutions Pvt Limited

. Managing an Auditing 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.

. 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

. Managing projects individually.

. 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 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 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 conducted by AAPC -

American Academy of Professional Coders in May 2007.

. Worked in various pilots projects for US and UAE

. Participated coding seminars conducted by AAPC.

. Stay 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 )

. 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

. 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 Payer-Provider

. Recently 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.

Clinical Experiences: Billroth Multispecialty Hospitals & ALA Memorial

Nursing Home

*Billroth Hospitals, Chennai.

Duty Medical Officer Feb 2006 to Feb 2007

Roles and Responsibilities:

o Taking care of the patients in the floor allotted by conducting

regular rounds and informing patient's status to respective

consultants,

o 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,

o Post-operative cares for surgical patients such as catheter removal,

drainage tube removal, suture removal, change of wound dressing etc..,

o Performing ward procedures of GJ tube, NG tube removal, PICC line

removal, etc..,

o Taking care of regular dialysis patient as checking the status of AV

shut, regular monitoring of BP, Pulse, Temperature etc..,

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

required,

o 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. Sep 2004

to Oct 2005

Residential Medical Officer

Roles and Responsibilities:

o Conducing daily rounds for post-operative & general wards and

providing patient care & counseling on suture removal, dressing,

drainage removal etc

o Assisting and Providing consultations for the Outpatients(Obstetrics,

Non-Obstetrics & Pediatric)

o Providing antenatal, postnatal and neonatal care and counseling,

o Assisting in conducting normal & caesarian deliveries and pediatric

procedures and vaccinations.

> Post-Graduation in Medical Sociology - MSc from University Of Madras (

2009 -2011 ) with a first class with more than 75 percentage.

> BSMS 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)

PERSONAL INFORMATION

Name : J.Jemimah Crescentia.

Husband Name : J.P.Victor Jabaraj.

Date of Birth : November 04, 1980.

Gender : Female.

Language Proficiency : English (R/W), Tamil (R/W), Hindi (R/U).

Passport Status : Active (G1239058)

Visa Status : Resident - Active

Permanent Address : No.5, 1st Kattabomman Street,

R.V Nagar,

Kodungaiyur,

Chennai - 600

118.

Declaration

I hereby declare that the information given above is true to

the best of my knowledge.

DATE :

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

OBJECTIVE

Brief Overview

Total Work EXPERIENCE OF 7 years along with 5 years in Medical CODING

PROFESSIONAL EXPERIENCE IN MEDICAL CODING

PROFESSIONAL EXPERIENCE IN MEDICAL CODING

PROFESSIONAL EXPERIENCE IN MEDICAL CODING

monthsmonths

Academic Achievements

Contact this candidate