Riayati
Aswani Ashokan
Medical Insurance Coordinator
Ras Al Khaimah ,United Arab Emirates
Summary
Experienced and accomplished medical Insurance coordinator with over 4 years of experience, seeking to leverage extensive claim processing guidelines knowledge and strong analytical skills to implement smooth claim submission.
Overview
4
4
years of professional experience
3
3
years of post-secondary education
4
4
Languages
Work History
Medical Insurance Coordinator
Smilecare Medical Center
Ras Al Khaimah , United Arab Emirates
07.2021 - Current
- Managing coordination of all aspects of insurance process which includes pre-approvals, medical billing and invoicing, coding by using CPT® and ICD-10-CM code sets. Conducting Medical Reviews to validate and assure medical record documentation is complete and billed services are justified and compliant as per the patient’s health insurance policy.
- Obtain Prior Approval or Authorization for dental and medical cases.
- Prepares insurance forms and associated correspondences.
- Coordinating, Liaising and networking between insurance companies regarding eligibility, payments, approvals, reconciliation and other requirements.
- Responsible for filing and tracking of daily insurance claims and informing patients of their claims status.
- Process Insurance and disability claims in a timely manner.
- Discusses the reasons for any rejected approval request with the concerned Doctor/ Nurse, to make it materialize into a confirmed approval.
- Review denial reasons and audit the claims in order to generate justification for resubmission. Managing resubmission of denial claims with the standard time frame as per policies and procedure of the department.
- Empanelment of insurance companies for both medical and dental services.
Claim Submission Officer (Team Lead)
VPS Groups, Dynamed Healthcare Solutions
10.2017 - 02.2020
- Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according toproductivity and quality standards.
- Maintained above 95% accuracy and productive quality.
- Ensures that targets are met for department turnaround time, quality and productivity.
- Re auditing the claim for avoiding rejections. Cross-checking patient details with insurance information and online portals, verifying accordingly.
- Identify and report back any type of claims observation or issues that may affect the process.
- Collect and analyze claims data to identify and resolve errors, delayed claims and processing issues.
- Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management.
- Checking and verifying approvals based on guidelines.
- Support the manager in implementation of quality assurance program inorder to maintain standards of quality and minimize fraudulent claims.
- Maintain confidentiality with regarding to the information being processed, stored or accessed. Completes other projects and duties as assigned.
- Handled UAE claims as per HAAD and DHA guidelines for about 22 hospitals , Clinics and Day care center like Burjeel Abu Dhabi, MedeorHospital, Lifecare , Medeor Dubai, Burjeel Day care surgery center.
Education
EDUCATIONALHISTORY -
St.Josephs College
BSC ZOOLOGY -
University of Calicut
05.2014 - 01.2017
Skills
Well experienced in SAP,INSTA and Unite software
Affiliations
Medical Billing course from CIGMA Medical coding &billing Academy 2017
Software
Unite
SAP
Insta
Clinic soft
Eclaim
Cerner
Timeline
Medical Insurance Coordinator
Smilecare Medical Center
07.2021 - Current
Claim Submission Officer (Team Lead)
VPS Groups, Dynamed Healthcare Solutions
10.2017 - 02.2020
BSC ZOOLOGY -
University of Calicut
05.2014 - 01.2017
EDUCATIONALHISTORY -
St.Josephs College
Personal Details
Date of Birth: 04/04/1997
Nationality : Indian
marital status : Married
Passport num : U5223772
Declaration
The above information is true to the best of my knowledge and belief.
Aswani Ashokan
Personal Details
Date of Birth: 04/04/1997
Nationality : Indian
marital status : Married
Passport num : U5223772
Declaration
The above information is true to the best of my knowledge and belief.
Aswani Ashokan
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