RIA ROSARIO BUSTAMANTE

Contact # : 00-971-**-*******

Email: adzrj9@r.postjobfree.com

Summary of Qualification:

Over 15 Years experience in Medical Records and Clerical Services.

Certified Professional Coder CPC- AAPC

Certificate for ICD- 10 Proficiency

12 years experience in Medical Coding and Billing.

Certificate in Coding Assesment and Training Solutions- Ahima

Experience in Medical Insurance Claims processing.

Knowledge of Medical Terminologies.

Knowledge on Medical Coding using ICD-10, ICD 9 and CPT-4 codes.

Graduate of four-year course with degree of Bachelor of Science in Secondary Education major in English.

Attained units in Bachelor of Science in Nursing.

Knowledgeable in Microsoft Office ( Excel, Word, Powerpoint and Internet)..

Ability to communicate effectively verbally (can speak English, Tagalog and basic Arabic)

Professional Experiences:

Ambulatory Health Services

Ambulatory Health Services- Seha

Disease Prevention and Screening Services

Abu Dhabi UAE

May 2009- Present

Position: Clinical Coder Coder

Job Description

Evaluates, codes and monitors physician's documentation,ICD 10 CM ICD 9 CM, evaluation and management (E&M) and other CPT-4 procedural codes for accuracy prior to claim submission.

Reviewing and analyzing patient medical records to ensure all applicable patient data is available for coding .

Abstracting pertinent information from patient records and assigning the relevant codes.

Assigning appropriate codes for pre-authorization purpose.

Revieiwng and assigning appropriate E&M’s codes based on Clinican’s documentation available in medical records, to ensure proper re-imbursement for the facility.

Querying physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes

Contacting the department/section or clinic and obtaining copies of additional documentation

Ensuring accurate coding and sequencing as specified by established coding principles and guidelines, following the clinical coding system

Allocating the appropriate and specific codes from the indexing system and assigning the codes for completing coding summary of the medical records

Assisting with the preparation of medical records for the quality assurance and medical audit purposes by providing the coding data.

Validating that encoded information is reported with most accurate information.

Timely analysis, notification and completion of medical records as per the facilties chart completion policies and procedures, regualatory and accreditation standards.

Reporting defaulters to the Senior Clinical Coding Officer for further actions.as per the facilities policy and procedures.

Daman- National Health Insurance Company

Claims Department- Third Party Administration

July 2008- May 2009

Position: Receiving Unit Agent

Job Scopes: Claims Receiving Agent, Medical Claims Processor

General Clerical Description:

Receiving and preapration of medical claims from the individual members for reimbursement, quantitative and qualitaitve checking based on the standard policy procedure on submission.

Retrieving medical claims for reconciliation and preparation of the claims for re-processing.

Responsible for escalating costumer issues of reimbursement claims from insurance sales agent to medical claims processors for reconciliation.

Receiving of medical claims- quantitative and qualitative checking and ensures that healthcare providers follow on the standard procedure on submission.

Preparation and distribution of medical claims to the medical processing unit.

Scanning annd indexing medical claims and ensuring data encoded are correct based on the company’s information system(Mednext)

Reports to the supervisor/ head of unit regarding feedback or observation and claim status submitted by the providers.

Al Rahba Hospital

December 2005- July 2008

Position: Medical Records Technician

Job Scopes: Hospital Ward Clerk, Registration Clerk, Receptionist,, Data Entry Operator

General Clerical Description:

Extracting and entering data of the patient in the system.

Processing admissions, transfers and discharges of the patients

Filing of medical records with accordance to the medical records assembly order.

Secure important documents of the patients such as passports, health insurance and etc.

Coordinates with the insurance coordinators for the patients' pre- authorization for hospitalization.

Making and receiving telephone calls and taking messages.

Ensure that all the Trust and Policies, procedures and confidentiality of the patients informations are adhered to tha strictest standards.

Contribute the health, safety and security of the working environment by familiarizing and complying with set policies and procedures.

Work cooperatively with other members of ward/ department team.

References and Authenticated Documents are available upon request.

Contact this candidate