Divesh Khatwani

• Build & implement Medical Coding logics & rules leveraging AI using Natural language processing (NLP) & Machine learning (ML) algorithms.
• Communicated effectively with team members to deliver updates on project milestones and deadlines.
• Developed product documentation to communicate upcoming features and products to internal teams.
• Perform continuous testing and assurance from medical coding perspective to maintain a highly intelligent medical coding solution supporting both the CM-version (Clinical modification) & AM-version (Australian modification)
• Thrived in fast-paced, highly-adept team to develop and prioritize product features and build product roadmap.

• Experience in handling entire facility independently, with team of 10+ coders, working in various specialty coding projects.

• Manage client SLAs (turn-around-time, quality)
• Daily workflow management & assigning work to team members according to the volume.

• Production planning and daily work management, movement of resource on required basis
• Problem-solving support for day-to-day issues.

• Specialties handled - Pain Management, Ambulatory Surgery Centers, Anesthesia, Evaluation and Management, Interventional Radiology (IVR) and In-Patient Diagnosis-Related Groups Coding (IP-DRG)

• Improved medical coding accuracy by conducting thorough reviews and implementing corrective actions.
• Work collaboratively with patient account department to ensure accurate billing and resolve claim denials and medical-necessity issues
• Multi-specialty, Ambulatory Surgery coding, Orthopedics, Radiology, Anesthesia, E/M & IVR Coding as well.
• Ensured compliance with industry regulations by staying updated on current coding practices and CMS guidelines.
• Manual Testing on Salesforce for EHR Development based on CMS guidelines.
• Working with claim rejection, payer rejection, Comply LCD and NCD policy to resolve the rejection.
• Health information Management & requesting update for Clinical Documentation Improvement (CDI) with Physician.

• Reviewed patient charts to better understand health histories, diagnoses, and treatments.
• Reviews physician assisted diagnosis code and procedure after thorough review of the medical
  record & if necessary, queries physician for additional clarity in a professional manner.
• Utilizes online coding references to include AHA Coding Clinic for ICD-10 CM, AMA CPT Manual,
  Official Guidelines for Coding & Reporting, Coding Handbook, Coder’s Desk Reference, AMA CPT
  Assistant.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.

• Responsible for calling insurance companies and obtaining claim status from different payers & documenting it in the system.
• Provide accurate product/ service information to customer, research available documentation including authorization, nursing notes, medical documentation on client's systems, interpret explanation of benefits received etc prior to making the call.
• Extract the ERA (Electronic Remittance Advice) & EOB (Explanation of Benefits) from various systems and websites & post the payment in the system based on it.