Amarnath Thogluva Varadhan
Abudhabi,UAE
Summary
Accomplished professional with extensive expertise in medical coding, DRG optimisation, and case management. Proficient in insurance pre-authorisation, claims processing, denial management, and appeals. Adept at utilising ICD-10, CPT, HCPCS, IR-DRG codes and ensuring compliance with industry standards. Skilled in revenue cycle analytics, process improvement, and quality control. Experienced with EHR systems, billing software including 3M Encoder and SAP, as well as EMR systems. Strong background in policy interpretation, insurance knowledge, dispute resolution, claims auditing and tracking. Committed to enhancing operational efficiency through advanced medical coding software and billing systems.
Driven professional with keen focus on delivering results and achieving excellence in claims management. Proven skills in risk assessment and negotiation, combined with strong analytical and communication abilities. Committed to enhancing operational efficiency and ensuring customer satisfaction.
Overview
18
18
years of professional experience
5
5
years of post-secondary education
1
1
Certification
Work history
Group Coding & Claims Manager
Burjeel Holdings
Abu Dhabi
06.2023 - Current
- Developed strategic plans for the Claims Department ensuring operational efficiency.
- Streamlined communication channels between clients and insurers, improving relationships and trust levels.
- Monitored pending claims inventory regularly keeping them within acceptable company standards.
- Developed training materials for new hires, enhancing their understanding of company policies.
- Ensured proper documentation for all processed insurance claims was maintained meticulously for future reference needs and audits requirements.
- Coached junior team members on effective claims handling techniques that resulted in enhanced service delivery.
- Created an environment conducive to teamwork, boosting overall productivity levels.
- Maintained compliance with industry regulations whilst handling insurance claims.
- Conducted fraud investigations, reducing false claims significantly.
- Coordinated with internal departments for seamless claim processing operations.
- Managed claims department, resulting in improved team performance.
- Assisted in policy development to reduce potential liabilities.
- Prepared detailed reports on claim trends, aiding management decision-making processes.
- Reduced claim processing times by implementing efficient work-flow strategies.
- Reviewed complex claims to ensure accurate payouts.
DRG Case Manager
Burjeel Holdings
Abu Dhabi, UAE
12.2021 - 05.2023
- Ensured continuity of care by developing effective discharge plans.
- Delivered professional development workshops with focus on case management techniques.
- Updated patient files regularly maintaining accurate records at all times.
- Liaised effectively with other professionals such as doctors, nurses and therapists in order to provide coordinated service delivery.
- Maintained strict confidentiality regarding patient information according to legal guidelines.
- Oversaw discharged plans after completion of treatment.
DRG Case Manager
Mediclinic Parkview Hospital
Dubai, UAE
09.2020 - 08.2021
- Managed inpatient admissions and DRG assignment, ensuring accurate documentation of MCC & CC conditions for optimal reimbursement
- Liaised with physicians to align medical management with payer policies and improve resource utilization
- Conducted departmental training sessions on insurance requirements and DRG severity enhancement
- Coordinated patient transfers to long-term care/rehabilitation centers, ensuring continuity of care and compliance
- Provided financial guidance on DAYCASE vs IPDRG to improve cost-efficiency and reimbursement
DRG Case Manager
NMC Royal Hospital
Khalifa City, UAE
06.2019 - 08.2020
- Ensured accurate DRG assignments by collaborating with treating physicians to document all relevant clinical conditions
- Conducted regular audits to ensure compliance with DAMAN and THIQA payer requirements
- Assisted in final DRG determination in collaboration with insurance providers
- Trained healthcare professionals on insurance policies, documentation best practices, and financial impact of coding choices
Medical Coder
Burjeel Hospital
Abu Dhabi
02.2016 - 05.2019
- Assigned ICD-10, CPT, and HCPCS codes for preauthorization, outpatient, inpatient, and daycare claims following standard coding guidelines
- Worked closely with physicians and medical teams to ensure documentation accuracy, improving claims approval rates
- Managed denial appeals, providing coding justification and guideline references to insurance companies
- Identified and resolved bundled CPT code errors, ensuring proper reimbursement per international coding standards
Team Leader - Medical Coding
India Healthcare Solutions Pvt. Ltd.
03.2014 - 02.2016
- Supervised coding teams and developed compliance strategies to improve coding accuracy and efficiency
- Audited medical claims, identified errors, and implemented corrective training for coders
- Managed process improvements for a new homecare client, stabilizing their coding workflow
Senior Medical Coder/Auditor
E4E Healthcare Business Services Pvt. Ltd.
04.2007 - 03.2014
- Audited medical reports across specialties like Surgery, E&M, Radiology, and Interventional Radiology
- Conducted focused audits, educated teams on coding corrections and compliance
- Provided training to new coders, enhancing team competency and accuracy
Education
Master of Marketing Management - Distance Education
Annamalai University
01.2008 - 01.2010
Bachelor of Science Microbiology -
Pachaiyappa's College
India 04.1999 - 04.2002
Skills
- Medical Coding,DRG Optimization
- Insurance Pre-Authorization,Claims Processing,Denial Management
- ICD-10
- CPT
- HCPCS
- IR-DRG
- Compliance
- Revenue Cycle Analytics
- Process Improvement
- 3M Encoder
- SAP
- Citrix
- Bayanaty
- Medical Coding Software
- Billing Systems
- EMR Systems
- Microsoft Office Suite
- Policy interpretation
- Insurance knowledge
- Dispute resolution
- Medical terminology familiarity
- Claims auditing
- Claims tracking
- Claims and risk data analysis
- Quality Control
Certification
- Certified Professional Coder (CPC), AAPC, 01/01/11
- ICD-10 Proficiency Assessment, AAPC, 01/01/16
Languages
English
Tamil
Hindi
Personal Information
- Passport Number: L1022179
- Date of birth: 06/27/80
- Nationality: Indian
Custom
I hereby declare that all information provided is true and correct to the best of my knowledge.
Timeline
Group Coding & Claims Manager
Burjeel Holdings
06.2023 - Current
DRG Case Manager
Burjeel Holdings
12.2021 - 05.2023
DRG Case Manager
Mediclinic Parkview Hospital
09.2020 - 08.2021
DRG Case Manager
NMC Royal Hospital
06.2019 - 08.2020
Medical Coder
Burjeel Hospital
02.2016 - 05.2019
Team Leader - Medical Coding
India Healthcare Solutions Pvt. Ltd.
03.2014 - 02.2016
Master of Marketing Management - Distance Education
Annamalai University
01.2008 - 01.2010
Senior Medical Coder/Auditor
E4E Healthcare Business Services Pvt. Ltd.
04.2007 - 03.2014
Bachelor of Science Microbiology -
Pachaiyappa's College
04.1999 - 04.2002
Similar Profiles
VIPIN RAJEEVVIPIN RAJEEV
OR CO-ORDINATOR at Burjeel Holdings (Burjeel Hospital Abu Dhabi & Burjeel Medical City)OR CO-ORDINATOR at Burjeel Holdings (Burjeel Hospital Abu Dhabi & Burjeel Medical City)
Kamaljit KaurKamaljit Kaur
Revenue Operations Manager at Burjeel Day Surgery Center, Burjeel HoldingsRevenue Operations Manager at Burjeel Day Surgery Center, Burjeel Holdings
Mohamed AbdelmoneimMohamed Abdelmoneim
Administrative supervisor at Burjeel HoldingsAdministrative supervisor at Burjeel Holdings
BHARATH KUMAR BHARATH KUMAR null
QHSE officer at Burjeel HoldingsQHSE officer at Burjeel Holdings
ANNITAH TUHAIRWEANNITAH TUHAIRWE
Security guard at HEMAYA SECURITY SERVICESSecurity guard at HEMAYA SECURITY SERVICES