Jayashree Govindaraj

**, *****************,****************, *********, ***********, India 605110

Mobile No: +971*********, +918*********

ac3dwe@r.postjobfree.com

Professional Summary

Hard Working and fully certified Medical coding Specialist has a full understand of ICD-9-CM, ICD-10-CM, ICD-10-PCS and CPT and DRG coding, Excellent Data entry skills allows for accurate coding of medical Information and 6+ years of experience. A Health Claims Specialist Certified by the AAPCand AHIMA seeking a position in which my skills and talents can contribute to a company in the health care industry.

Skill Highlights

Knowledge in Medical Coding – ICD-10-CM, ICD-9-CM, CPT,HCPCS and ICD-10-PCS Coding Guidelines

IR-DRG Classification

Utilized various coding books, procedure manuals and on-line Encoder pro, Medical code expert, 3M as a resource

Medical Terminology Strong work ethic and HIPPA

Knowledge of anatomy/physiology, Medical abbreviation and terminology

Excellent interpersonal and communication skills

Protected patients’ healthiness information for privacy

Handled all kinds of insurance claims

Very efficient in using MS Office Software, including MS WORD, EXCEL, POWER POINT, Query Processes and Able to type 55+ wpm

Work Experience

1.GMC Hospital –Thumbay Hospital - AJMAN

(Medical coder from Sep 16, 2015 to Present)

Inpatient Coder (DRG coding)

• Review patients’ documentation to determine diagnosis, co-morbidities and complications

• Use technical coding principles and reimbursement expertise to assign proper diagnosis and procedures

• Verify that each code assigned is accurate and correlates to the condition and diagnosis Provide in the source document

• Identify non-payment conditions and report them through specified procedures

• Serve as a resource for coding related queries after verifying authenticity of inquirer

• Ascertain that quality and integrity of coding including accurate determination of principle diagnosis and secondary diagnosis is accurate

• Provide support in maintaining acceptable accounts receivables

Achievements:

Successfully coded 25 to 30 inpatient records and 160 OP within a record time

Maintained patient data integrity during a complex system conversion process

Commended on keeping patient data confidential and safe even during a near-lethal cyberattack on the patient information system

Successfully obtained CPT code for prior authorizations for all assigned patients

Educated to the doctor for proper documents for accurate coding

Outpatient Coder

• Verified outpatient information regarding diagnosis and treatment

• Punched information into the coding system using prescribed outpatient codes

• Ascertained the accuracy of codes according to specific procedures performed

• Responded to queries for information regarding medical procedures performed on particular patients

Query the physician if any discrepancy of documents

• Recorded information regarding reason for short patient visit, type of illness and breakdown of the treatment provided.

Claim verification & Submission Process:

Verified health insurance policies for all major Insurance like Daman, Nas, Neuron ect.

Check for the medical necessity for each billed service and drugs by validating the CEED.

Verification of approved code for drugs and some services as per insurance policies and attaching the pre-authorization letter to submit the claims.

Examined pertinent information to determine the accuracy of client requests and related paperwork

Maintained and revised procedural lists, control records and coded schemes to process source data

Followed up with decisions from providers if any changes with service code or procedure

Prior Authorization

Receive the pre-approval form and verify requests for prior authorizations and ensure that they are administered properly.

Consult with presiding doctors or nurse managers to obtain clearance for the medical necessity of treatment.

Look through insurance plans in a detailed manner and process required referrals.

Given proper CPT code for Prior Authorization.

Sort medical records and submit them to the carrier in a bid to expedite the authorization process.

Verify patients’ benefits and ensure that proper prior authorization and re-authorization is obtained for additional treatment.

Medical Record Department:

Responsible for handling Medical records in confidential manner

Preparing monthly reports and submitting to the HIM officer

Scanning of the medical record and export to the online

Co-ordinate the HIM activities

Coordinate with the clinicians and ensure complete source department

Coordinate with OPD clinic for managing the patient file movement

Check current chart for the competence and accuracy

Submitting monthly or yearly Quality indicator for Diagnosis and Procedure

1.Ahalia Hospital - Hamdan, Abudhabi

(Medical coder from Feb 15, 2015 to June 10, 2015)

Performed Outpatient coding

Coding of patient’s chart using ICD-9 Code, CPT

Tracking down of requested medical records.

Utilized various coding and on-line 3M

Conducted peer reviews to ensure compliance with coding guidelines.

Maintained strict patient and physician confidentiality.

2.e4e Business Solutions India Pvt Ltd

(100 Feet Rd, Kovilambakkam, Tamil Nadu, Chennai, India

Medical coder from July 25, 2013 to November 12, 2013)

Review patient’s e-medical records

Performed Emergency room service coding (Facility coding)

Maintained strict patient and physician confidentiality with 98% of quality.

Utilized various coding books, procedure manuals and on-line Encoder pro as a resource

3.Episource India Private Limited

Nandanam, Chennai, Tamil Nadu 600028

(Executive coder from November 18, 2013 to Dec 12, 2014)

Performed HCC coding (Hierarchical Condition Categories)

Coding of patient’s chart using ICD-9 Code.

Tracking down of requested medical records.

Utilized various coding ICD books and on-line, Medicalcode expert as a resource

Maintained strict patient and physician confidentiality.

Coding Auditor till Dec 12, 2014

Audited all types of records for quality of coding in coordination with the Clinical Documentation Specialists.

Accomplishments

oTrained Beginners in Medical coding

oTrained around 80 coder for Molina project.

oTrained coders for CPC exams.

oTrained experienced coder and auditors from other team to my team

oContacted monthly Auditor meeting with coders to maintain good quality and quantity

oContacted meetings for refresher class

oClarified doubts to my team members( Team members around 50 to 80)

oCollecting new provider formats and taking class.

oSharing my Knowledge through mails in daily basis

4.Ajuba Solutions India Private Limited

Chennai, Tamil Nadu, India

(Medical coderOfficerfrom May 11, 2011 to July 23, 2013)

Code medical records with ICD-9, CPT-4 coding, processing 60 to 90 claims daily while maintaining 98% accuracy and achieving productivity goals.

Utilize Epic software and input information into computerized patient record system.

Duties also include handling wide variety of medical claims including physical therapies, ENT, primary care and psychiatry visits, dental, eye/vision, surgeries, diagnostic testing, ER, and E&M.

Department CodingSpecializations Listed: Coded Outpatient, Consultancy, Emergency room (trauma registry), Surgery and diagnostic ancillary services.

Utilized various coding books, procedure manuals and on-line 3M as a resource.

Accomplishments

Quality coder,

Hard work and punctuality

Trained Beginners in Medical coding

Trained coder for CPC exam

Contacting Mock test and clarify doubts

Certification

Certified Professional Coder from AAPC

ICD-10-CM Certification from AAPC

Waiting for CCS result from AHIMA

DRG overview Local chapter from AAPC

Going to appear for CPMA exam from AAPC

Education Qualifications

M.Sc., Biotechnology. (Bharathidasan University).2008-2010.

B.Sc., Biotechnology -Indira Gandhi College of arts and science (Pondicherry University) 2005 – 2008

PG Diploma in Bioinformatics.(Bharathidasan University) Trichy. (2008-2010)

Diploma in Computer Application (May, 2005).

Medical Coding Training (FIIT) 2 months

Personal Details

Name : G.Jayashree

Date of Birth : 29.10.1987

Nationality : Indian

PassPort No : L2285091

Married status : Married

Languages known : Tamil, English

Declaration

I hereby declare that all the information given above is true to the best of my knowledge.

Yours sincerely (G.JAYASHREE)

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