Medical Information Security

Career Objective:

To obtain a position in a company where I can maximize my organizational skills and to succeed in an environment of growth and excellence which will provide job satisfaction that will help me achieve the organizational goals.

WORK HISTORY

MEDICAL CLAIMS OFFICER

German Heart Centre FZ LLC, Dubai

November 1, 2019 – Up to present

Duties:

• Examine the eligibility and table of benefits for the member to specify if the claim will be paid using direct billing or reimbursement basis.

• Receive and review patient charts for proper documentation that will be used if there is a need for approval.

• Communicate with other clinical staff to validate information.

• Assign codes to diagnosis and procedures, using ICD 10, CPT and HCPCS codes.

• Ensure the accuracy of codes in accordance with DHA and insurance regulations to avoid rejections.

• Follow up with the provider on any documentation that is insufficient or unclear.

• Manage monthly claim submission and resubmission smoothly. INSURANCE COORDINATOR

Al Bustan Medical Centre LLC, Sharjah

October 5, 2018 – October 3, 2019

Duties:

• Analyze patient records and set an established and detailed medical codes to bill insurance/ TPA.

• Always interact with physicians to ensure accuracy of information.

• Handle daily approvals and outbound/inbound calls.

• Keep communicating to insurance/TPA regarding new circular and other important update.

• Meet daily code production.

• Managing monthly submission/resubmission and make sure to upload generated claims properly.

• Maintain patient confidentiality and information security. LEOMAR DAQUIZ

A: Sheikh Rashid Bin Saeed Street, Manila Opticals Bldg. Abu Dhabi, U.A.E

E: ************@*******.***

M: 056*******

INSURANCE CLERK – GENERAL

Al Dhafra Insurance Company P.S.C, Abu Dhabi

May 1, 2016 – May 9, 2018

Duties:

• Assess and process outpatient/inpatient claims such as direct billing, resubmission and reimbursement claims.

• Evaluate medical necessity and consistency of diagnosis, procedure and drug codes and descriptions stated on the claims according to accepted medical coding rules and guidelines.

• Process claims according to expected daily target and quality.

• Ensure accurate application of contractual prices and discounts, collection of deductibles, copayments, observance of policy limits, and adherence to claims submission protocols.

• Contribute in developing, updating and implementing the guidelines for evaluation and processing of medical claims, as well as policies and procedures.

• Communicate work related issues clearly and effectively with the team members and superiors.

• Answering calls for queries and medicine/admission approval.

• Deliver high quality customer service and respect medical and work ethics at all time. DATA PROCESSOR

German Health Consult FZ LLC, Dubai

April 6, 2014 – April 8, 2016

Duties:

• Enter data by inputting alphabetic and numeric information (ICD, CPT and HCPCS codes) using an established procedure and through a detailed web-based interface.

• Analyzes and scans documents for proper diagnoses and accuracy of information.

• Obtain further information for incomplete documents.

• Maintain customer confidence and protects operations by keeping information confidential.

• Consistently deliver a high-volume output without compromising the quality of work provided. EDUCATION

Bachelor of Science in Nursing (4 year course, A.Y. 2006 – 2010) Nueva Ecija University of Science and Technology, Philippines Bachelor’s Degree in Computer Science (1 year complete, A.Y. 2005 – 2006) College for Research and Technology, Philippines

PERSONAL PROFILE

Nationality : Filipino

Visa Status : Employment

Notice Period : 30 days

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