Claire Ann Flores
Abu Dhabi
Summary
Medical Billing and Coding Specialist with 13 years of providing administrative and patient support in homecare,hospital and medical office settings in USA and United Arab Emirates. Advanced knowledge of private insurance processes and codes and revenue management.
A certified professional coder from AAPC with more than ten years of insurance management and medical coding working experience with USA based company and in the United Arab Emirates.
Licensed nursing professional with four years of broad-based working experience in community healthcare, hospital, and acute care setting in the Philippines and Singapore. Has invaluable administrative experience as head nurse and clinical instructor
Overview
17
17
years of professional experience
Work History
Revenue Cycle Team Leader/ Medical Coder
Via Medica International Healthcare LLC
01.2022 - Current
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes for Abu Dhabi, Dubai and Sharjah.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in homecare setting. Acted as Team Leader for homecare coders in Abu Dhabi, Dubai and Sharjah.
- Ensured compliance with industry regulations and guidelines by staying up-to-date on the latest coding changes. Garnered A rating in JAWDA Data Certification.
- Contributed to revenue growth by identifying undercoded and uncoded services for proper reimbursement.
- Streamlined the billing process for faster reimbursement by submitting accurate and timely insurance claims.
- Recovered payment and submitted 1.2M of unpaid invoices by Neuron neglected by previous coders.
- Reconciled and resubmitted 1.92M of ABM rejected claims for 2021-2022, over 1M of which are reconciled and considered upon coder's justifications and evidence submission.
- Managed to have Zero Minor or Major Non-Conformity on Claims Management Process during JAWDA Audits.
Claims And Encoding Manager
Dmetco Home Healthcare
06.2021 - 12.2021
- Manages group of encoders and claims officers for the Department of Health Home Isolation Program for Covid 19 Project
- Trains new staff on encoding and claiming process using Estijabah system
- Submits management report and statistical data to DOH for the Home quarantine and Home Isolation cases
- Sends claims and reconciles remittances
- Creates policies and target KPI for the project
- Ensures smooth flow of day to day operation and implements Standard Operating Procedure in congruent with DOH standards.
Insurance Specialist/Coding Manager/ HR Admin Officer
British American Healthcare
11.2015 - 06.2021
- Liaises with insurance companies regarding eligibility, payments, approvals, reconciliation, and other requirements
- Submits and follows up pre-authorization and requests to DAMAN and/or other affiliated insurance providers in a timely manner
- Manages and sends eclaims to DAMAN for payment of services rendered
- Sends invoices and provide billing services for both Thiqa and self-paid patients
- Performs as the Authorized Compliance Representative of British American Healthcare LLC for JAWDA Data Certification (JAWDA A rating)
- Record keeping of all patient files and pre-authorizations submitted and received
- Manages revenue cycle and prepares report for billed claims and remittances
- Co-manages Human Resource Department that includes Immigration, Ministry of Labor application, and DOH licensing
- Recruitment of nurses, caregiver, and Admin support staff.
Claims Analyst/Medical Coder/Quality Auditor
IMS Health
01.2013 - 07.2015
- Codes medical records including demographics, diagnosis, pharmaceutical products, desired actions, drug issuance as prescribed by a universe of physicians and medical facilities
- Correlates diagnosis and pharmaceutical products and their indication and dosage information
- Converts diagnosis reported in ICD 10 to equivalent medical diagnosis available in the database
- Serves as liaison officer between physicians, pharmaceuticals, and insurance companies
- Audits medical records coded by analysts/coders.
Claims Analyst/Medical Coder
Accenture
01.2011 - 12.2012
- Determines pre-existing condition based on member health plan
- Requests medical records and subject them for review
- Serves as subject matter expert and trains new analyst in pre-existing review and ICD coding process
- Audits medical records coded by analysts/coders
- Performs admin and quality control tasks including updating Operational Excellence board, submitting daily report, etc
- Presents the process to future clients and investors.
Special Education Nurse
Cambridge Child Development Center
07.2008 - 03.2010
- Responsible for providing care for preschool children with special needs and abilities
- Assess children's condition, recording medical histories and vaccination records
- Administers medication and treatment
- Performs diagnostic tests and procedures
- Develops program for young children to stimulate creativity and cognitive abilities.
Head Nurse
Rosary of Virgin Mary Hospital
07.2007 - 05.2008
- Supervises nursing and health allied staff to ensure the best care will be given to patients
- Assigns duties and organizes shift patterns
- Ensure medical records are maintained and the clinical team is adhering to policies and government mandate
- Evaluates the performance of nursing staff and health aides.
Staff Nurse/Clinical Instructor
Rosary of Virgin Mary Hospital
06.2007 - 05.2008
- Performs physical exams and takes patients' history
- Provides health promotion, counseling, and education
- Administers medications, wound care, and other personalized interventions
- Coordinates care with other healthcare professionals
- Supervises midwifery and health aide students in their clinical affiliation
- Teaches basic nursing care, anatomy and physiology, and patient-health practitioners interaction
- Prepares and evaluates students for their readiness in clinical duty and certifications.
Education
Certified Medical Coding Course -
American Association of Professional Coder
04.2016
Bachelor of Science in Nursing -
Centro Escolar University
04.2006
Skills
- ESTIJABAH SYSTEM
- ELECTRONIC MEDICAL RECORDS
- HR AND PAYROLL SYSTEM
- MEDICAL CODES AND TRANSCRIPTIONS
- CODING AND BILLING SOFTWARE
- ADMINISTRATIVE TASKS AND POLICIES CREATION
- JAWDA/ADHICS/ACCREDITATION AUDITS
- DUBAI AND NORTHERN EMIRATES GOVERNMENT MEDICAL RECORDS SOFTWARE
- REVENUE CYCLE MANAGEMENT AND BILLING CYCLE
- STAFF EDUCATION AND TRAINING
Awards
- First Employee to be Awarded Employee of the Month- Via Medica Healthcare LLC Abu Dhabi
- Exemplary Performance in Insurance Management- Annual Award- Via Medica Healthcare LLC Abu Dhabi
- Annual Management Award for Exemplary Performance - British American Healthcare Abu Dhabi
- Most Valuable Employee - British American Healthcare Abu Dhabi
- Employee of the Month - British American Healthcare Abu Dhabi
- Loyalty Awardee( 5 Years) - British American Healthcare Abu Dhabi
- Annual Top Performer - IMS Health USA Outsource
- Most Valuable Processor Award - Accenture USA Outsource
- Academic Excellence Awardee ( Cumlaude)- Centro Escolar University Philippines
References
Mary Almai, CEO, British American Healthcare LLC, ceo@bahealthcare.ae, +971566419738
Timeline
Revenue Cycle Team Leader/ Medical Coder
Via Medica International Healthcare LLC
01.2022 - Current
Claims And Encoding Manager
Dmetco Home Healthcare
06.2021 - 12.2021
Insurance Specialist/Coding Manager/ HR Admin Officer
British American Healthcare
11.2015 - 06.2021
Claims Analyst/Medical Coder/Quality Auditor
IMS Health
01.2013 - 07.2015
Claims Analyst/Medical Coder
Accenture
01.2011 - 12.2012
Special Education Nurse
Cambridge Child Development Center
07.2008 - 03.2010
Head Nurse
Rosary of Virgin Mary Hospital
07.2007 - 05.2008
Staff Nurse/Clinical Instructor
Rosary of Virgin Mary Hospital
06.2007 - 05.2008
Certified Medical Coding Course -
American Association of Professional Coder
Bachelor of Science in Nursing -
Centro Escolar University
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