D Kalyan Kumar
Sharjah
Summary
Accomplished professional with extensive expertise in medical coding and classification systems, including ICD-10-CM, CPT, HCPCS, DSL, DRG Grouping, and HCC Coding. Demonstrates proficiency in clinical documentation improvement and regulatory compliance with DHA and MOH standards. Skilled in insurance and claims management, preauthorization processes, denial management strategies, and adherence to payer policies. Adept at technical and analytical tasks such as EMR utilisation, XML file handling, data validation, quality audits, and root cause analysis. Committed to maintaining HIPAA compliance and patient data confidentiality while optimising workflows through collaboration with physicians and billing teams.
Overview
9
9
years of professional experience
2015
2015
years of post-secondary education
1
1
Certification
Work history
IP DRG Coder / Insurance Coordinator
HMS AL GARHOUD PRIVATE HOSPITAL
08.2024 - 11.2025
- DRG Coding Accuracy & Compliance: Ensure precise assignment of ICD-10-CM and CPT codes for inpatient encounters, achieving optimal DRG grouping in full alignment with DHA and payer guidelines.
- Clinical Documentation Improvement (CDI): Collaborate with physicians and clinical teams to validate and enhance documentation, driving improved case mix index (CMI) and accurate reimbursement outcomes.
- Audit & Quality Assurance: Conduct regular coding audits and data validation checks to uphold coding integrity, reducing DRG mismatches and maintaining top-tier audit performance.
- Claims Coordination & Denial Reduction: Coordinate with billing and insurance teams to resolve coding-related discrepancies, accelerating claim approvals and reducing denials.
- Process Optimization & Training Support: Streamline DRG workflow processes and contribute to coder training sessions, promoting consistency, efficiency, and compliance across the coding department.
IP Approval Coder & Claims Submission Officer
BURJEEL SPECIALITY HOSPITAL / SHARJAH
Sharjah
03.2023 - 08.2024
- Insurance Eligibility & Pre-Authorization Expertise: Executed thorough verification of patient eligibility, policy coverage, and approval criteria, ensuring complete compliance with payer and DHA regulations.
- Accurate Clinical Coding & Documentation: Applied precise DSL, ICD-CM, and CPT codes aligned with DHA standards, securing timely approvals through accurate and comprehensive clinical documentation.
- Cross-Functional Collaboration: Partnered closely with physicians to enhance documentation accuracy, reducing insurance rejections and minimizing claim denials significantly.
- Claims Submission & System Proficiency: Ensured prompt claim submission by managing final authorizations and expertly handling uploads and XML error resolutions in RIAYATI and DHPO systems.
- Process Optimization & Compliance Excellence: Streamlined coding and claims workflows, reinforcing compliance, accelerating approval turnaround, and improving overall claim success rates.
Senior Medical Coder (HCC Coding)
OPTUM HEALTH AND TECHNOLOGIES PVT LTD / BENGALURU
Bengaluru
06.2020 - 12.2022
- High-Precision HCC Coding: Delivered exceptional coding accuracy by assigning risk-adjusted ICD-10-CM codes for outpatient encounters, fully compliant with CMS and project-specific guidelines.
- Clinical Data Validation: Enhanced code validity through meticulous analysis of medical records and integration of additional diagnostic codes supported by clinical documentation.
- Leadership & Team Support: Served as Acting Team Lead, providing targeted training, mentoring, and feedback to uplift team accuracy and consistency.
- Quality & Compliance Excellence: Maintained superior audit scores by enforcing rigorous QA checks, ensuring 100% adherence to compliance standards.
- Process Improvement & Efficiency: Contributed to workflow optimization initiatives, reducing turnaround time and boosting team productivity in high-volume HCC coding projects.
Medical Coder
ASTER DM HEALTH CARE / BENGALURU
Bengaluru
05.2018 - 02.2020
- Precision Coding & Compliance: Delivered 100% accuracy in ICD-10-CM and CPT code assignments for outpatient and inpatient cases, adhering to DHA and insurance guidelines.
- Clinical Data Integration: Enhanced diagnostic specificity by incorporating clinical insights from lab, pathology, and psychological reports into coding workflows.
- Authorization & Claim Accuracy: Ensured seamless claim processing by meticulously verifying prior authorizations and aligning with payer approval protocols.
- Process Optimization & Error Reduction: Streamlined coding operations, reducing rework and claim denials through rigorous quality checks and documentation accuracy.
- Regulatory & Quality Excellence: Maintained full compliance with coding standards, contributing to improved audit scores and overall departmental performance.
Process Associate (ED Professional)
AGS HEALTH / TIRUPATI
Tirupati
05.2017 - 02.2018
- Advanced Clinical Coding Accuracy: Ensured 100% accuracy in assigning ICD-10-CM and E&M codes for inpatient diagnoses and procedures, enhancing claim precision and compliance.
- Quality & Compliance Assurance: Strictly adhered to AAPC and coding clinic standards, maintaining consistent audit-ready documentation and regulatory compliance.
- Coding Edit Resolution: Proactively identified and resolved coding edits, strengthening data integrity and minimizing claim denials.
- Cross-Functional Data Integration: Integrated diagnostic insights from lab, pathology, and psychological reports, improving case completeness and code specificity.
- Process Efficiency & Performance: Streamlined the coding review workflow, contributing to faster turnaround times and improved departmental accuracy metrics.
Education
B Pharmacy -
Sree Vidyanikethan College of Pharmacy
TirupathiHigher Secondary - undefined
Sri Siddhartha Junior College
MadanapalleSSC - undefined
Vijaya Bharathi High School
MadanapalleSkills
- Clinical documentation improvement
- Eligibility verification systems
- Policy understanding
- ICD-10-CM coding
- CPT coding accuracy
- DRG optimization techniques
Certification
- CPC - 2022
- AAPC - 02003432
- CCS - 2019
- AHIMA - 233850
Languages
Languages Known: Telugu, English
Timeline
IP DRG Coder / Insurance Coordinator
HMS AL GARHOUD PRIVATE HOSPITAL
08.2024 - 11.2025
IP Approval Coder & Claims Submission Officer
BURJEEL SPECIALITY HOSPITAL / SHARJAH
03.2023 - 08.2024
Senior Medical Coder (HCC Coding)
OPTUM HEALTH AND TECHNOLOGIES PVT LTD / BENGALURU
06.2020 - 12.2022
Medical Coder
ASTER DM HEALTH CARE / BENGALURU
05.2018 - 02.2020
Process Associate (ED Professional)
AGS HEALTH / TIRUPATI
05.2017 - 02.2018
Higher Secondary - undefined
Sri Siddhartha Junior College
SSC - undefined
Vijaya Bharathi High School
B Pharmacy -
Sree Vidyanikethan College of Pharmacy