Anitha Xavier

• Check eligibility and benefits-make sure insurance coverage before service

Review and validate codes- verifying correct coding accurate, payer policies.

• Provide completed and accurate information-missing incomplete, missing information in claim form to avoid delays, denials, audits or penalties
• Working on Daily Basis Medical Coding on IP/OP & LTC Claims
• Review the Medical Records for accurate coding and hence maintaining the compliance with the coding guidelines
• Raising Query clarification to Physician on regular basis for Documentation deficit and other MNEC query for OP/LTC Claims
• Working on claims approvals, submission, Resubmission and getting updated on denial scenarios in denials claims have hand full of experience in justifying the reasons given by insurance
• Responsible for handling different types of medical claims
• Challenges & monitors the compliance of the Doctors for making sure the claims will be devoid of Up coding, Down coding, Unbundling or Bundling Coordinates with the dependency units such as MRD, Admissions, Doctors, Nursing, Lab, Pharmacy to get the Coding corrected on medical coding Guidelines be it code or Documentation whichever is deficit Always comply with HAAD rules and regulations regarding Health Information, Coding and
• Reimbursement.

• Clinic
• Evaluating the claims for submission to the Insurance companies
• In duties pertaining to patient billing, communications with health insurance, collections, cash posting
• Monitor coding of visits, identify opportunities for quality improvement and implement/secure training as needed
• Prepare detailed analyses and reports of billing and accounts receivable activity and results, including outstanding payment
• Ensure that unprocessed claims and denials are reviewed, reworked, and resubmitted to ensure revenue maximization
• Educate the physician for code highest specificity of diagnosis, discrepancy and improve documentation
• Highly skilled in abstracting information and assigning codes to describe each documented analysis
• Ensure that appropriate coding is managed in order to maximize efficiency

• Update the team regarding quality issues if any and areas of concern to help eliminate repetition of errors Responsible for complete and accurate assignment of ICD-10-CM and PCS procedure codes in accordance with current internal and external coding guidelines High motivated ability to work independently
• Proven ability to meet deadlines in high pressure environment with keen attention to detail
• Experience in different types of encoder software including 3M and Winstrat, Citrix, Code remote as we as a wide variety of different electronic medical record system including EPIC
• Experience in Internal and External audit and send feedback based on the audit report.

• Hands on experience auditing emergency department physician and facility coding diagnosis and procedures using ICD-10-CM and CPT Processing the reports of patients from emergency department departments
• Ensuring the reports with more than 98% quality
• High motivated ability to work independently
• Proven ability to meet deadlines in high pressure environment with keen attention to detail
• Experience in Internal and External audit and send feedback based on the audit report
• Update the team regarding quality issues if any and areas of concern to help eliminate repetition of errors
• Motivating and improving the morale of the team
• Ensure that appropriate coding is managed in order to maximize efficiency Handle billing related activities focused on medical specialties

• Experience in HCC Coding Medicare Risk Adjustment Coder Performs clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives
• Hands on experience in Emergency Department & Medicare Risk Adjustment Coding
• Experience in Internal and External audit and send feedback based on the audit report
• Motivating and improving the morale of the team
• Emergency Department Coding (Professional & Facility), E & M & Radiology coding
• Related Skill Sets Fast learner and highly motivated to perform tasks; constant drive for perfection
• Get adapted to new places and get cross-training on new domains very easily within a short span of time
• Self-confidence and optimistic attitude.