Insurance Medical

CAREER OBJECTIVE

Achievement - Driven professional seeking senior level assignment in insurance / coding & billing / revenue cycle operations with leading organizations of repute preferably in healthcare sector.

12 years of dynamic career reflecting pioneering experience and record breaking performance in driving RCM, coding and billing process pertaining as per standards

Profile Summery

•A dynamic professional with extensive experience in insurance, Coding & billing and revenue Cycle Operations

•Well experienced HIM coding, Billing, insurance and claim process under various platforms with extensive experience under hospital & Practice management

•Adrift in HIM & Revenue cycle process, Billing & Eclaims, Process Integration, EMR,coding, process transitioning,authority regulations & billing requirements,six sigma methodology and MR documentation

•Adept in maintaining effident documentation as per local authority regulations & billing requirements

•A visionary & high performance Management executive,with expertise in validating data in different areas and transcribing which involves transitioning new process and stabilizing the smooth for operations

•Skilled in carrying out development of periodic reports for clinical staff and recognizing unbilled charges due to inadequate documentation

•Steering role in handling the unpaid claims from insurance companies for various denial reasons,claim correction and resubmission in specified time limits

•Significantly involved hospital revenue enhancement and various department like insurance finance & HIM

•Possess extensive experience in identifying documentation requirements,acquiring authorizations, pre-approval request and claim correction / modifications & price negotiations

•proficient in managing, motivating and leading teams for running successful business process operations with proven ability of achieving service delivery or process targets

•Adroit at maintaining cordial relationship with customers, ensuring quality and service norms thereby achieving customer satisfaction and business retention

•Motivational management style with record building & retaining highly motivated teams & prestige’s key accounts

•Demonstrated excellence in carrying out quantitative & qualitative auditing and developing electronic health records, transition from physical paper records to electronic, voice transcription and implementation

•Adept in imparting training on documentation to doctors and other healthcare professionals

•Delivered a dynamic breakthrough by setting up the quality of standards, ensuring high quality customer experience, while adhering to SLA and work processes

•Exceptionally well organized and detail oriented with an ability to meet deadlines

WEALTH OF EXPERTISE

Insurance – HIM & Medical Coding – Billing and Eclaim process – Account Receivables – Denial management /Analysis & Resubmission – IT support – EMR implementation – Process transition & Enhancement –Team management – Operations – Revenue Capture & Enhancement – Flaw Identification – Rectification – Process design & Implementation

CONVERSENT WITH FOLLOWING:-

HAAD /DHA /SCH Policies and Guidelines & CMS /AMA /CCSC Process guidelines

All Major insurance company policies and guidelines, payment methodologies (fee for service /DRG / per Diem)

Medical Coding – ICD 9 CM, ICD 10 CM & PCS, CPT, ICD 10 AM & ACHI, CDT. CDA /ADA & HCPCS, APC, IR & MS DRG, HCC coding and SNOMED CT

Billing & E claims – US & UAE Billing process & systems

Billing applications – GE centricity, Mysis Tiger, IDX, Cerner Soft med, Clintrac, Medron, Office Ally, ERP, Hospycare

Billing types – Facility (DRG) / physician (Fee for service, Per diem) / ASC /LTC / Pain Mgmt. . . . / Chemotherapy etc...

SKILLED IN :-

Carrying out insurance billing, cash billing & corporate billing

Preparing & submitting (manual & electronic) and coding insurance claims accurately

Tracking and updating on systems – ICD 9 CM, ICD 10 CM, CPT, CDT, HCPCS and DRGs (IR & MS) on a regular basis

Implementing insurance eligibility checklist and verification process

Developing an application with in HIS enabling users to identify the potential areas of errors before patient is registered and also before submission of claims

Performing prompt posting of payments and reconciliation process

Designing and preparing customized monthly statistical and analytical dash boards for data tracking and operational purpose

Handing data accuracy enabling data management at operations and finance departments for resource utilization patient wise revenue Vs costs effectively

Designing work flow processes and IT support for hospital information systems for effective documentation, data capture

Reducing variances between finance /accounts & claims

CAREER MILESTONES

Significantly functioning as the active member of

Revenue Cycle steering committee at DrsulaimanAlhabib Hospital, Lifeline, Zulekha & Armada

Established effective Coding & billing dept. & process

Implementation of coding process & designed effectively state of art coding billing and process

Accomplishing JCIA for hospitals Drsulaimanalhabib & Lifeline

Clinical Coding Steering committee and coding arbitration, HAAD – Abu Dhabi

Designed and implement effective HIS –EMR system

Designing coding / billing HIS-IT (ERP) system for effective billing/ claiming process

Process integration for better process, effective staffing and cost control

Accredited for transitioning process of HIM / coding in compliance to HAAD /DHA /SCH standards in UAE & US

Steering role in designing the process flow for inter departmental (PSD / Admission office – HIM – insurance) process flow for timely billing

Acknowledged with the letter appreciations for minimizing the variances between Hospital finance system (ERP) vs eclaims

Flourishingly completed projects on:

Effective usage of consumable ( purchase request –dispatch – OR utilization –HIS – Coding /Billing )

EMR interface and Billing process – User friendly system design

Laboratory /Radiology interdepartmental His work flow – starting from Registration /Order service – Prior Authorization – Results – Claims

HIM & Hospital information System – Coding & billing System Development according to internal process and migration project from physical to electronic record management & claims

Significantly delivered a seminar on DRG coding (Importance – Applications) & basis requirements Vs hospital revenue

ORGNISATIONAL EXPERIENCE

1.Since Jan 2017 onwards - Manager Coding, Billing and CDI - Zulekha Hospital Dubai & Sharja

2.Sep 2013 to Dec 2016 - Medical Coding & Pricing Analyst - DrSulaimanalhabib Hospital Dubai

3.Dec 2011 to Aug 2013 - Head of Medical Coding & Resubmission - Lifeline Health care Dubai

4.Jan 2011 to Dec 2011 - Manager Insurance & Payer contracting - Armada Surgical Center Dubai

5.Feb 2008 to jan 2011 - Senior Insurance Coordinator - Al Raha Hospital Abu Dhabi

ACCOUNTABILITIES

1.Handling entire gamut of HIM & revenue cycle processes and recognizing areas enhancement

2.Executing adequate measures for maximization of customer satisfaction level

3.Monitoring the activities pertaining to work allocation and training & recruitment

4.Administrating the overall daily operations of organizational unit ascertaining compliance with laws, policies & regulations

5.Developing slandered operating procedures ensuring SLAs

6.Accountable for migration of systems to upgraded versions for attaining maximum efficiency in various operations related to EMR, coding / billing

7.Heading the process improvement initiatives

8.Identify clients requirements and developing, implementing & transitioning the process accordingly

9.Developing & implementing workflows of facilitation of structured in all areas & issues

10.Responsible for planning & organizing in – service programs for patient care process

11.Maintaining medical records and identifying & correcting problems

12.Executing quality control audits through six sigma methodology

13.Supporting physicians / providers in matters pertaining to MR documentation, coding, billing and insurance policies

14.Accountable for identification of prospective insurance companies, review of agreements, price negotiation and contract finalization

15.Ensuring compliance to insurance policies & protocol as per agreement

16.Interfacing the insurance companies to ensure approval of problematic cases

17.Recognizing the exhausted benefits in coordination with re – submission team for maximum recovery from insurance companies

18.Carrying out insurance disallowance reasons, recognizing enhancement areas identifying and implementing the changes

19.Ascertaining timely submission of insurance department statics on monthly basis

20.Assisting the credentialed and supervisory staff in continuing education efforts and encourage meetings

21.Carrying out evolution, educating and enhancement areas identified and implementing the changes

22.Recognizing the productivity and quality standards according to departmental & Organizational guidelines

23.Developing reports and appropriately utilizing the findings performance improvement activities and HIM services

24.Serving as the active member of hospital governance committees, management information systems, documentation improvement committees, Revenue cycle review committees, enterprise wide electronic medical records ( EMR ) committees, Accreditation committees and investigation and review board for Research management

Attended the following

1. HIMSS ICD 10CM / PCS workshop, Abu Dhabi – UAE

2.ICD – 10 AM certificate of attendance by representative from WHO, Doha – Qatar

3.HIM conference,Abu Dhabi – UAE

4.CCSC certification on coding E& M for OP, Emergency Dept. . . . Homecare, etc. …

5.80 hour comprehensive training program from PMCC certified trainer ( Regina A, Blakeslee, RHIA ) for CCS ( AHIMA)

6.Six month comprehensive training program in medical transcription by ETOS school of medical transcription, Hyderabad

Imparted training to candidates on coding certifications (CPC, CPC- H, CCS, CCS-P & CCA)

IT skills

1.GE centricity, Mysis Tiger, IDX, Karee & Hospycare

2.Medron, Lanvision & HIS

3.Cerner Softmed / Clintrac / Power chart, ERP

4.Inge nix EncoderPro, Winstart and 3M Encoder

5.MS office and Windows 95/2000/xp/7

EDUCATION

Certification

CPMB (certified professional medical biller) from PMBA

CPC(certifiedprofessional coder)from AAPC

CCA(certified coding specialist) from AHIMA

Other Qualification

BTEC HNC (hospitality higher national certificate) from edexal UK

BBC English edge from BBC active UK

Academic

B –Pharm .University of Calicut, Kerala India

MBA in health care systems. Sikkim manipal university, India

Pursuing Master of Public Health in university of Derby, United Kingdom

LinkedIn:

https://www.linkedin.com/pub/abdul-shahir-cpc-cca-cpmb/16/7a9/81

PERSONAL INFORMATION

Birth Date :1 may 1984

Gender :male

Nationality :India

Visa Status :Residence Visa

Residence Location :Dubai, United Arab Emirates

Marital Status :married

Driving License :United Arab Emirates

Languages Known : English & Hindi

TO WHOM IT MAY CONCERN

My aim is to obtain a demanding position related utilizing the skills through my education and experience, build up and develop my knowledge. If you choose me, I am sure that I will represent an invaluable asset to any work in your Department.

I see myself as resourceful, creative, and solution-oriented person with good quality written and verbal communication skills. When it comes to sense of duty, I continuously work under pressure and handle multiple tasks at the same time. I would consider it to be a pleasure working in your esteemed organization if I am given a chance to serve under you.

I am looking for a work that is directly and indirectly related to my past work experiences. I’m a man of determination and I am determined in facing, exploring and learning different professional categories and different work areas or company set up. I love being surrounded and with different types of people. I love communicating with them, learning their insights, culture and character. I am very patient in listening to their-own story and problems. It’s a feeling of reward and gladness whenever I can reach out and help others

Thank you very much for your time and effort. If you have any questions or concerns, please feel free to call me at 052*******

Sincerely,

Abdul Shahir EV

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