Anees Makbul

1. Perform Medical Record audits for inpatient,long term and daycare based on organizational priorities. Coding reviews and/or Audits may lead to the addition, deletion, adjustment or confirmation of diagnoses and procedure.

2. Review of inpatient,long-term and daycare audit results with CDI team. Assist in creating and communicating provider and vendor education regarding trends and areas of opportunity regarding compliant coding practices.

3. Researched knowledge in DoH adjudication and billing rules.

4. Remain updated on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance.

5. DRG optimization and CMI improvement is also a prime focus.

6. Providing Reports related to status of coding and billing, concurrently.

7. Researched knowledge in Tasneef(Jawda) and Daman audit process.

Additional skills and responsibilities.

• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Learned new skills and applied to daily tasks to improve efficiency and productivity.
• Worked with customers to understand needs and provide excellent service.
• Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
• Carried out day-to-day duties accurately and efficiently.

• To analyze and process the medical claims, mainly E-claims.
• To take payment orders as and when required.
• To deal with issues related to E-claims and online line claims, discussing with IT and networks.
• To communicate with providers for payment related issue.
• Issue the approvals or denial for PBM, based on eligibility and coverage.
• framing of Pharmacy benefit management by Setting up rules, Update drug information,Set up entities for the program,Improve automation for easy process and Branded-Generic listing are the prime focus of process.