REFERRED BY: MR.ABDUL MALICK
SENTHILKUMAR NATARAJAN, BPT, CCS, CPC.
MEDICAL CODING PROFESSIONAL
Respected Sir\ Madam,
I am submitting here with my resume for your perusal and favorable consideration for the post of Medical Coder /Insurance coder in your organization.
Qualified with Bachelor of Physiotherapy (B.P.T) from Dr.MGR Medical University, with excellent professional & technical skills achieved via rich cross-functional exposure of over 8.5 years in Medical Coding; currently spearheading with Awazen Specialty Medical Center -Abu Dhabi as a Senior Medical Coding Specialist.
My core competencies are in the domain of Medical Coding and Auditing, Submission, Resubmission, Approvals.
I am an innovative thinker, able to apply analysis and creativity to problem solving. I am a highly personable, self-motivated and diligent individual with flexibility to adapt to new situations.
Driven by high energy levels and technical competence I am confident of making visible contribution to organization's growth and profitability objectives.
A tour through my enclosed resume shall take you through the details and I am confident, in my credentials you would find a perfect fit for the said job. Thank you for sparing your time.
MEDICAL CODING PROFESSIONAL
Seeking professional role in the domain of Clinical Data Management/Revenue Cycle Management
Motivated and Multi-Skilled Medical Coding professional with experience of over 8 years in predominantly with a renowned Health Care Management Company
Adequately acquainted with Medical Coding standards and procedures & Day Care Surgery coding (CPT), ICD 10-CM, (in Cleveland Clinics) and ICD 9-CM, ER and E&M coding (Audit & Denial Management) and Healthcare Common Procedure Coding System (HCPCS).
Capable of setting up perfect coordination with various departments and people to achieve and maintain high professional standards in the assigned job; wide experience in techniques & guidelines of medical coding & Auditing including –Ambulatory & Day Care Surgery billing and Resubmission.
Sound knowledge of medical terminology, anatomy, physiology, pathology and pharmacology and Radiology coding; adept in handling the client transitions and software migrations, effectively and efficiently. Fine-tuned analytical and troubleshooting skills.
EDUCATION & TRAINING:
Bachelor of Physiotherapy (B.P.T); 2008 White Memorial College of Physiotherapy (Affiliated to Dr. MGR University, Chennai)
LICENSES 1: CPC ID- 01215832 (Certified Professional Coder)
Certified by AAPC (American Academy of Professional Coders)
LICENSES 2: CCS ID-2819155 (Clinical Coding Specialist)
Certified by AHIMA (American Health Information Management Association)
Munich Medical and Rehabilitation Specialty Medical Center- Al Ain (April- 2018 to still present)
Senior Medical coding Specialist & Insurance Coordinator
Working as an end to end process (Submission, resubmission, auditing)
Submitting daily coding report and collection report to the Insurance manager
Coding & Auditing OP medical records & consultation reports using proper E/M codes based on 1995 Guidelines for different specialties like Pediatrics, Orthopedics, Internal Medicine, Obstetrics & Gynecology, Dermatology, General Surgery, General practitioner, Physiotherapy and Dental (USC& LS) along with, lab & diagnostic testing etc.
In addition, communicate with various insurance companies for all insurance related queries, insurance factor value and Remittance Advice.
Re submission: Review the rejected claims from the insurance & resubmit the claims with appropriate medical justification as per the HAAD guidelines & Insurance and coding guidelines.
Conducting periodic power point presentations to the physicians, nurses and insurance department to assist them for proper documentation, billing to reduce the denials.
To avoid future denials updating doctors of different specialties based on recent rejections and updates from the insurance company as well.
Awazen medical specialty center –Abu Dhabi-(April-2018 to March-2020)
Senior Medical coding Specialist
Doing outpatient medical records/documents coding for submissions as per coding guidelines (ICD-9 CM & CPT -4) mandated by Abu Dhabi Health Authority.
Reviewing medical records and assigning accurate and auditing claims daily basis,
Working as an end to end process (Submission, resubmission, auditing, billing),
Assigning ICD and CPT codes to Outpatient E&M records
Re Submission: Review the rejected claims from the insurance & resubmit with appropriate medical justification as per the HAAD guidelines &insurance, coding guidelines.
Represented as nominee for JAWDA Audit for outpatient coding (2018&2019)
Sending pre- approval for outpatient& day care procedures claims and dental.
Represented as lead for E4 for the year (2015,2016,2018,2019)
Validate the medical claims to ensure whether service like lab, radiology, drugs, treatment procedures are covered by insurance with respect to insurance, HAAD manual, adjudication rules, mandatory tariff & green rain codes.
Cleveland Clinics, (Ocshi Outsourcing Management) - Abu Dhabi. (Jan 2017 to Feb -2018)
Senior Medical coding Specialist
Assigning ICD and CPT codes to Inpatient & Daycare Surgery records in accordance with the UHDDS coding guideline
Have trained in ICD 10 CM by AHIMA ICD 10 professional trainer.
Assigning CPT and ICD codes for Daycare surgeries and using with 3M software.
Responsible for handling the insurance clarifications and reporting the details to the insurance on timely basis.
Handling Rejections and Resubmitting the E claims according to HAAD policy
Communicating documentation improvement opportunities and coding issues to appropriate personnel
Tracking own continuing education credits to maintain professional credentials
Communicating with co-workers, management, and hospital staff regarding clinical and reimbursement issues
Maintain thorough knowledge of HAAD specifications in order to offer best service.
Query physician for clarification when documentation is inadequate, ambiguous, or unclear for coding purposes.
Al Madina Medical Center, Abudhabi, UAE. (June 2014 to Sep 2016)
Medical Records Coder and Claim processor
Reviewing medical records/clinical notes for patient and assigning accurate codes for diagnosis/conditions and procedures using ICD-9-CM, 10 CM.
Sequencing medical diagnosis and procedures using standard coding guidelines and Abu Dhabi (HAAD) Health Authority guidelines.
Doing outpatient medical records/documents coding for resubmissions (E-claims) as per coding guidelines (ICD-9 CM & CPT -4) mandated by Abu Dhabi Health Authority.
Having strong knowledge in all insurance cards, Denial codes, calculations, Ability to recognize the Denial codes and their denotation, submission, resubmission.
Ability to analyze the rejected claims and find out the possible reason for rejection and re-submit the claims with proper justification and documents.
Abstracting the clinical information from patient’s Medical records/EMR and assigning appropriate diagnosis with ICD 10 or 9 codes and assigning CPT, service codes to support the denied claims.
Coordinating with insurance companies for prior authorization and other claim related queries.
US HEALTHCARE EXPERIENCE (INDIA)
From SEP 2010 to APRIL 2014
Omega Health care, Chennai (coder & Senior Coder)
E4E, CHENNAI (Coding Quality Analyst & Compliance Auditor)
Gained in-depth knowledge of coding techniques and guidelines of medical coding then auditing the medical records (CPT, ICD, HCPCS) coded by team.
Proactively involved in checking the quality of claims (Bundling CPTs and inappropriate modifier 25, 51 and 59-Separate Procedure).
Imparting knowledge & assistance to the team whenever deemed necessary, thus playing an important role in team building.
Audit –Retrospective E/M audit was done for Medicare claims to determine whether over payment on claims have been made to particular physician practice for the facility using trailblazer audit tool.
Denial Management –Resubmitted the claims either rejected from insurance or navicure (front office) by appropriate correction with detailed explanation as per the general coding guidelines and insurance specific rules.
Assigning diagnostic and procedural codes to ER Medical records.
Reviewing the surgery reports and assigning CPTs along with appropriate modifier for minor & major procedures
Proactively involved in checking the quality which are coded by other coders and educate them to maintain 97% of quality.
Attended coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
Knowledge of disease processes and procedural techniques to consistently apply the correct codes.
Date of Birth : 20th MAY, 1984
Languages Known : English and Tamil
Permanent Address : 110/51C,Veeriyan Kottai (PO), Peravurani (TK), Tanjore
Passport No : L7813849 valid till: 09/03/2024
I hereby declare that all the information given above is true to the best of my knowledge.
Place: Abu Dhabi yours sincerely,
Date: Senthilkumar Natarajan