Gayle Ann F. Fallarco BsN, CCS,CPC

Having * years of experience as Outpatient Medical Coder, Biller and Document Management in the Healthcare Industry both in United Arab Emirates and Philippines ACHIEVEMENTS

• Board Passer of Nursing Licensure Examination in the Philippines.

• Certified Coding Specialist (AHIMA)

Member ID: 2828000 – November 25,2019

• Certified Professional Coder (AAPC)

Member ID:01330454 – April 30,2015

• ICD 10 Proficiency Passer

WORK EXPERIENCE

Claims Executive-Coder (Insurance Department)

Prime Medical Center/Hospital

Aug. 12,2018 - Aug.14,2020

Dubai, United Arab

Emirates

Key Responsibilities:

*Comply with all legal requirements regarding coding procedures and practices

*Conduct audits and coding reviews to ensure all documentation is accurate and precise

*Assign and sequence all codes for services rendered

*Collaborate with billing department to ensure all bills are satisfied in a timely manner

*Communicate with insurance companies about coding errors and disputes

*Submit statistical data for analysis and research by other departments

*Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients with regard to coding proceduresg

* Insurance Coordinator

– responsible for submitting of approval to the insurance based on the services/procedures that needs to be done in patient most specially with the above limit of based on their health insurances.

- Coordinating with the nurses for the approval send by the insurance.

* Resubmission

- Analyzing denial claims and justifying it as per denial reason.

- Determine and validate the final diagnoses is accurate in line with clinical documentation.

- Providing regular feedback to the management on areas of improvement based on the denial.

- Enabling good contacts with physician and other health care professional based on denial received so they can be aware what are the services usually rejected by the insurances E-mail: adhl9s@r.postjobfree.com Mobile: 050******* Address: Art II Building 30 cor 14 St.Bur Dubai,Dubai U.A.E. Coding In Charge (Insurance Department)

Al Musalla Medical Center (Avivo Group)

June 12,2016 - June12,2018

Dubai, United Arab

AVIVO Group is a healthcare service provider which is having 21 facilities (Hospitals, Diagnostic Centres, Medical Centres, Pharmacies, Home Care and Aesthetic Centres) across UAE and Kuwait. Key Responsibilities:

• Coding insurance claims for (Out-Patient) Medical Centres.

• Daily submission of insurance claims in DHPO via HIS.

• Determining Medical necessity for the procedures requested by the physician to avoid rejection.

• To discuss with the physician the procedures and diagnosis that requires further information and justification.

• Verifying the accuracy of pre-approval codes versus the codes provided by the physician.

• To help and assist the physician for proper documentation and EMR are completely filled out in HIS.

• Ensuring lab reports are uploaded in the system.

• Submitting Daily Production Report to the Insurance Manager.

• Assisted the Team Leader-Insurance Department in unification of codes and correct codes to propose to Insurance Companies.

• Educate billers, pre-approval, doctors to avoid rejections. Medical Coder II (Emergency Department-Logix)

Miramed Philippine

October 14, 2013 till March 23,2016

Pasig City, Philippines

Key Responsibilities:

• Receiving daily claims for coding as distributed by the Team Leader.

• Achieving beyond daily quotas provided to the team.

• Reading charts and all other medical related documentation to ensure proper coding is done and in proper order.

Reimbursement Biller for U.S. patients Arriva Medical August 2012 till January 2013

Document Management Specialist/Quality Assurance Maxi Care January 2011 till July 2012

Educational Background

• Emilio Aguinaldo College

Bachelor of Science in Nursing

Year 2004 -2008

Referral upon Request

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