SHOMA PRADEEP

Mob: 050-*******

email: adborf@r.postjobfree.com

Career objectives:

Secure a challenging position in financial sector where I can effectively contribute my skills. Education and course work:

Master of Science - Maths from Annamalai University.

Bachelor of Science - Computer science, Maths and Statistics from Mangalore University.

Medical coding (ICD 10 CM,CPT,HCPCS).

Professional summary:

Nine years of rich experience as a claims processing billing officer.

Professionally grown in a highly competitive business environment.

Excellent interpersonal, communications and organizational skills with abilities in team management.

Senior Billing Officer:

NMC Specialty Hospital, Dubai (2008 - 2017)

NMC Hospital, Hor Al Anz, Deira, Dubai (2003 - 2006) Roles and Responsibilities

Manage routine daily claims administration work, overall insurance claims, approval procedures, denials and receivables.

Update the preauthorization approval code received from Insurance Company immediately after receipt.

Ensure knowledge on deductibles, co-payments, co-insurance amounts, insurance exclusions and other policies of all insurances that the centre is dealing with.

Contact insurance companies for verbal approvals for necessary cases. Preparing cost breakdown of procedures prior to sending for approval to respective insurance companies. Previews the pending cases and follow up effectively on a daily basis.

Ensure accuracy of coded diagnosis, procedures and completeness of supporting documentation.

Coordinating with coders for correct billing as per ICD 10 and CPT coding.

Reviews patient files for re submission and follow up for the incomplete or missing documentation and coordinate with the appropriate clinical of medical staff to ensure the documentation is completed properly.

Providing medical justification for the re submission of rejected claims with insurance companies thru E claims and uploading XML’s in HAAD Post office(DHPO).

Analysis of patients’ medical data for completeness, accuracy to provide correct justification for the Insurance Company.

Maintains an average productivity rate of 50 to 100 rejected claims per day.

Ensure the appropriate coding of the primary and secondary diagnosis based on the patients file.

Monitoring and ensuring that the invoices are attached with all supporting documents I.e. e-claim forms,copy of lab reports, radiology reports discharge summary and all other related documents

Periodical outstanding statements sending to insurance companies for the payment follow up.

Resolving billing discrepancies with insurance companies.

Ensures and maintains confidentiality of patients protected health information in both electronic and paper formats

Ability to review the claims to ensure appropriate completion of CPT,ICD-9,HCPCS,DRG and Pricelist

Performed related duties as assigned.

Customer service executive cum Cashier

Muthoot Fin. Corp India (2018 -2019)

Roles and Responsibilities

Instant money transfer

Accepting and paying cash from/to the customers over the counter after due verification

Issuance of gold loan and auto loan

Installment gold scheme

Ticketing( Air, Railway and Bus)

Issuance of health guard(Medi claim)

Life insurance scheme and general insurance for vehicles Junior Officer:

UAE EXCHANGE CENTER LLC (2006 - 2007)

Roles and Responsibilities:

Exchange of permitted foreign currencies, subject to the compliance with formalized procedures.

Vigilance for any counterfeit notes.

Accepting and paying cash from/to the customers over the counter after due verification.

Physical cash balance verification

Ensure effective customer service

Promote mutual funds to the customers

Air ticketing

Instant money transfers.

Computer Skills:

Microsoft office suite

Expertise in working with Excel spreadsheets and word documents

Enterprise resource planning (ERP) Business management software

Hospital management system.

Personal Profile:

Nationality : Indian

Date of birth: 28-05-1977

Languages known : English,Malayalam, Hindi

Marital status : Married

Passport number :J1761270

Visa status :Residence Visa (Husband’s Sponsorship) Declaration:

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

Place: Al Nadha, Dubai,UAE

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