Abhilash K
RESUBMISSION OFFICER
Abu Dhabi
Summary
Certified CPC Medical and Dental Coder with over 7 years of experience in healthcare insurance coordination, claim resubmissions, denial management, and revenue recovery in the UAE (DOH) system. Adept at preparing appeals using clinical evidence, managing pre-authorizations, and coordinating with internal stakeholders to minimize claim denials. Skilled in analyzing denial trends, presenting performance metrics, and aligning with payer policies such as DAMAN and other UAE insurers. Proven ability to support audits, enhance compliance, and streamline revenue cycle processes. Actively seeking to contribute as a Senior Revenue Recovery Specialist / Resubmission Officer with SEHA.
Overview
9
9
years of professional experience
2015
2015
years of post-secondary education
1
1
Certification
Work History
Insurance Coordinator – Dental & Medical
Ahalia Medical Group
04.2019 - Current
- *Lead the coordination of pre-authorizations, coding, and denial resubmissions across multiple specialties, including Dental.
- * Conducted root cause analysis of denied claims and prepared appeals with clinical justifications in alignment with payer policies.
- * Regularly interacted with physicians, coders, case managers, and insurance companies to ensure accurate and timely claim processing.
- * Participated in internal audits and prepared documentation for external payer audits; ensured adherence to DOH guidelines and adjudication rules.
- * Maintained up-to-date knowledge of UAE regulatory changes and payer-specific clinical guidelines to avoid unnecessary denials.
- * Conducted monthly denial performance reviews and contributed to process improvement initiatives in coordination with billing and finance teams.
- * Provided training to front desk, nursing, and clinical staff to ensure accurate documentation and authorization workflows.
- * Expert in navigating various insurance portals, 3M software, and hospital information systems for claims and patient record management.
- *Key Achievements:
- * Successfully reduced the denial rate of dental claims by implementing structured documentation training for dental assistants.
- * Played a lead role in improving claim resubmission turnaround time by 25%, enhancing monthly revenue realization.
- * Conducted regular internal claim audits, helping to improve coding accuracy and compliance across departments.
Guest Relation Executive
Al Ahalia Hospital
05.2018 - 04.2019
- Managed patient registration, insurance verification, and appointment coordination across dental and OPD departments.
- Liaised between departments for test coordination, claim approvals, and billing clarifications.
- Maintained approval logs and ensured accurate documentation for all insurance claims.
Customer Relations Executive
Vodafone Cellular Ltd.
01.2016 - 01.2018
- Delivered high-level customer support, resolved technical and billing queries, and ensured service quality.
- Participated in initiatives aimed at improving overall team performance and enhancing the quality of support provided to customers.
Education
Bachelor of Science - Chemistry
University of Calicut
Diploma in Computer Application - undefined
Kerala State Rutronix
Skills
- Hospital Information Systems (HIS)
- Insurance Portals: DAMAN, Thiqa, NAS, Neuron, etc
- Microsoft Office: Word, Excel, Outlook
- Email Communication & Online Claim Platforms
- Customer service and assistance
- ICD-10 coding
- Claims
- Microsoft office
- Claims processing
- Insurance claims processing
- Revenue cycle management
- Medical billing and coding
- Insurance verification
- Dental insurance experience
Regulatory And Compliance Knowledge
- DOH (Department of Health – Abu Dhabi)
- UAE Medical Billing & Reimbursement Guidelines
- Payer-specific Clinical Policy Review
- Utilization Review and Documentation Standards
Certification
Certified Professional Coder (CPC) – AAPC ID: 01732937
Timeline
Insurance Coordinator – Dental & Medical
Ahalia Medical Group
04.2019 - Current
Certified Professional Coder (CPC) – AAPC ID: 01732937
03-2019
Guest Relation Executive
Al Ahalia Hospital
05.2018 - 04.2019
Customer Relations Executive
Vodafone Cellular Ltd.
01.2016 - 01.2018
Diploma in Computer Application - undefined
Kerala State Rutronix
Bachelor of Science - Chemistry
University of Calicut
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