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Medical Management

Location:
Al Ain, AZ, United Arab Emirates
Posted:
April 11, 2016

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Resume:

CURRICULUM VITAE

BALAKRUSHNA DASH, CMAS, CCS, CPC

AHIMA Certified ICD-10-CM/PCS Trainer/Ambassador

Al Ain Hospital, Al Ain, Abu Dhabi

Ph. No. 009***********

Email:acua98@r.postjobfree.com __ PASSPORT NUMBER: H7632920

CAREER OBJECTIVE: A lead role in Healthcare Industry where I can prove my skill set with respect to quality and productivity which are the basic needs for an organization’s growth.

WORK EXPERIENCE: 15 Years (5 years in UAE and 11 years in –USA Healthcare)

Working as a Sr. Medical Coder in Al Ain Hospital, Al Ain, Abu Dhabi UAE, from November 2011 to present.

Worked as a Medical Records Coder in Al Noor Hospital, Airport Road, Abu Dhabi, UAE, from February 2011 to September 2011.

Worked as an Assistant Manager, Quality in Apollo Health Street Ltd, Hyderabad, India from 3rd February, 2003 to September 2010.

Worked as a Proof Reader in Medical Transcription at ETS PVT Ltd., Secunderabad, Andhra Pradesh, India from December 2000 to January 2003.

CURRENT JOB RESPONSIBILITIES:

1. Daily work assignment to the coding team.

2. Monitoring and reporting the productivity of individual coder and the team.

3. Maintaining the coding Turn –Around-Time.

4. Conducting Internal Coding Audit and giving feedback to the coder.

5. DAMAN Recovery audit review analysis and actively participating in the DAMAN Recovery Audit meetings and rebutting the DAMAN feedback.

6. Actively supporting the denial management process.

7. Coordinating with the insurance/billing team to minimize the denial rate.

8. Preparing and updating the internal coding guidelines.

9. Supporting the clinical staff on Clinical Documentation Improvement.

10. Training the coders on the recent coding updates.

JOB KNOWLEDGE

1. Medical Coding Audit and Reporting

2. Medical Coding Training-Physician/Coder/Ancillary Staff

3. Clinical Documentation Improvement (CDI) Training for Physician

4. Physician Query

5. Denial Management

6. Healthcare Compliance (HIPAA)

7. Insurance Policies

8. Team Management

Knowledge of Medical Coding Classifications:

Knowledge of HAAD (Health Authority of Abu Dhabi) Coding Guidelines with related to below classifications:

1. ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) Trainer

2. ICD-10-PCS (International Classification of Disease tenth revision Procedure Coding System)- Trainer

3. ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification)

4. CPT -4 (Current Procedural Terminology)

5. HCPCS (Healthcare Common Procedure Coding System)

6. IR-DRG (International Refined Diagnostic Related Group)

7. MS-DRG (Medicare Severity- Diagnostic Related Group)

Specialty coding knowledge:

Hospital coding for Inpatient Department with IR-DRG/MS-DRG (Cerner/ AS400 and 3M DRG Grouper, Volume III codes.).

Hospital Inpatient (Physician) E/M Coding as per 1995/1997 E/M guidelines).

Ambulatory Surgery (Cerner/AS400 and 3M DRG Grouper, Hospital Facility Coding, Volume III codes.)

Emergency Department E/M coding as per 1995/1997 E/M guidelines.

Hospital Facility coding for Emergency Department as per ACEP guidelines (AS400 and 3M DRG Grouper, Volume III codes.).

Outpatient E/M Coding as per 1995/1997 E/M guidelines).

Radiology Diagnostic and Interventional radiology.

Psychiatry

Rehabilitation (Physiotherapy, Occupational Therapy)

Radiology (Interventional and diagnostic)

Medicine

Pharmacy

Laboratory

Pathology

Homecare

Insurance Policies: Knowledge of insurance policies of different groups.

Medical Necessity.

Deductible/Co-Payment/Eligibility.

Approvals.

Claim Denials and Re-appealing.

MEDICAL TRANSCRIPTION:

Proofreading different specialties of medical records.

QUALITY (AUDIT):

Preparation of Generic Audit Plan/Policy for the Audit Team.

Preparation of Specialty Audit Plan/Policy for the Audit Team.

Defining the Current Key Indicators based on the Trend Analysis and Latest Audit Report.

Creation of different Group/Individual Analysis Tools like Month-To-Day, Week-To-Month, Day-To-Day Error Analysis.

Classifying Error Categories such as Financial /Non-Financial Impacted, Training Errors, Negligence Errors, coding completeness etc.

Preparation of weekly, fortnightly and monthly Audit Reports and Dashboards on Trend Analysis, and Improvement Plan.

Re-auditing Policy on Auditor to check the data reliability, accuracy, and coding compliance.

Training Auditors and the Coding Team on updates and brain storming on critical charts.

Documenting the client specific updates and dissipating the same to the team members.

Defining the Audit% based on the trend analysis and other reports.

Preparation of Standard Professional Improvement Policy.

Monitoring and updating the process.

Research on new coding scenarios and addressing those updates (Data from CMS/AMA sites) to both Quality and Operation team.

OPERATION MANAGEMENT:

Client interaction with respect to volume management, quality and TAT. Adept in coordinating with clients & forging relations; interfacing with them to understand their requirements & provide customized services.

Conducting Monthly Review Meeting (MRM), fortnightly/monthly with Management. Giving them information related to Process Status with respect to volume management, accuracy, productivity, TAT with the help of Dashboards. Suggesting next plan of action (POA), if any.

Preparation of Status Report of Revenue Generation for each process.

Resource management (Staffing, Attrition management, and optimum utilization of resources).

Streamlining the process which includes process improvement (process reengineering), optimum system utilization.

Team appraisal.

Selection of Best Performers Award based on the performance on a quarterly basis.

Periodical Target Review.

TRAINING:

Physician Education on Coding and Clinical Documentation Improvement.

Giving training to experienced and non-experienced candidates.

Generic and specialty training.

Conducting preliminary evaluation of the assigned trainees to understand their skill set.

Preparation of the Training Module based on their skill set with keeping the company’s requirement and time frame in mind.

Periodic evaluation and up-gradation of the trainees from one level to another as and when they achieve the required accuracy.

Releasing the trainees to the floor once they successfully completed the training.

Post-training evaluation to measure consistencies. If needed, taking them back to the training program.

ACADEMIC PROFILE:

Post Graduate Diploma in Hospital Administration, Apollo Health and Research Education Foundation, Hyderabad.

B.Sc. in Zoology from Berhampur University, Orissa, India

Certified Medical Audit Specialist, AAMAS, USA, 2014

AHIMA Certified ICD-10-CM/PCS Trainer, Ambassador. USA

Certified Coding Specialist (CCS), from AHIMA, USA 2010.

Certified Professional Coder (CPC) from AAPC, USA 2002.

Certificate in Clinical Database Management, Clinova Research Laboratory, Hyderabad.

PGDCA from IGNOU, New Delhi, India.

Advance Diploma in Computer Application from TULEC, Orissa, India.

Diploma in Medical Transcription from CITES, BBSR, Orissa.

Active member of AHIMA.

Active member of AAHAM.

Active member of AAPC.

Active member of AAMAS.

PERSONAL STRENGTH: Co-ordination, Creativity, Determination,

and ready to accept the challenges.

PERSONAL DETAILS:

FATHER’S NAME: Late. BIJAYA KUMAR DASH

DATE OF BIRTH: 10/07/1976

MARITAL STATUS: MARRIED

LANGUAGES KNOWN: English, Hindi, and Oriya

PERMANENT ADDRESS: At/Po: Jarada Gada, Ganjam,

Orissa-761005

PASSPORT STATUS:

1. UAE -Residence visa

2. USA-Visit visa for 10 years

3. Canada-Visit visa for 10 years

DECLARATION:

I do hereby declare that the above-furnished information is true to the best of my knowledge.

Place: ABU DHABI, UAE

Date:

Signature of the candidate



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