Dr. Ayana Yesodharan (CPC)
Abudhabi
Summary
Professional with 13 years of comprehensive experience ready for this role. Equipped with strong skills in leadership, problem-solving, and strategic planning. Known for team collaboration and adaptability, consistently delivering results. Strong communicator with focus on integrity and accountability.
Possesses a strong work ethic, adaptability and passion for continuous learning and professional development to stay abreast of industry trends and advancements.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Pre- Authorization Officer
Abudhabi National Insurance Company (ADNIC)
04.2024 - Current
- Accurately assess and verify DRG (Diagnosis-Related Group) codes submitted for each diagnosis and procedure, ensuring compliance with medical coding standards.
- Conduct comprehensive reviews of inpatient and outpatient claims, validating diagnoses, procedures, and providing prior authorization as per established guidelines.
- Address and resolve complaints or grievance requests from patients and healthcare providers. Facilitate healthy discussions to ensure grievances are managed effectively while maintaining a focus on patient care and satisfaction.
Approval Officer: Pre-Authorization
National Life & General Insurance, Inayah TPA
04.2022 - 03.2024
- Evaluate and verify DRG codes submitted for each diagnosis of service and procedures according to the medical coding standards.
- Extensively involved in Inpatient and outpatient claim reviews and validating diagnosis procedures and providing prior authorization based on guidelines in 24/7 rotation shift.
- Prepare Prior Authorization claim approval data for detailed analysis and prepare standard preapproval guidelines and exceptions
- Handle Complaints or Grievance requests from both Patients and Health Care Providers. Ensure to have healthy discussions and make sure the Grievance are resolved ensuring Patient care. managers
Ayurvedic Doctor
Mantra Ayurveda Clinic
08.2017 - 09.2018
- Teamed with other physicians, specialists and health care providersto provide well rounded care for complex cases
- Administered high level of care to patients using active listening and open ended questioning
- Treated chronic and acute illness with supplements, medicines and lifestyle adjustments.
Senior Wellness Consultant
Sanda Retreats, Goa
03.2013 - 04.2017
- Organized and led seminars and classes for clients, providing tips and advice for lifestyle changes and healthy living according to ayurveda
- Developed care plans and agendas for patients based on individual health concerns and advised on specific diet and exercise plans.
Resident Medical Officer
V.M Salgaoncar Hospital
06.2011 - 03.2013
- Initiate and maintain continuous critical care for 24 hours rotation shift.
- Coordination on in-patient management in conjunction with other health professionals.
- Collected information about patient histories, current conditions and vital statistics to make accurate determinations about conditions
Education
Master - Business administration- Healthcare services
Sikkim Manipal University
2017
Bachelor of Ayurvedic Medicine & Surgery -
Goa University
2012
Skills
- Pre-Approval evaluation- IP/OP and pharmacy
- Case Management
- Cost Containment
- Underwriting
- Knowledge in DRG medical adjudication rules
- Claims investigation and Audit
- Insurance regulations
Accomplishments
- In 2017, was one among the speakers for public awareness on the topic of ‘Postnatal care for mother and newborn' conducted by “Her heath first” at Radisson Blue, Deira, Dubai, United Arab Emirates
- Spearheaded impactful health awareness initiatives, delivering educational talks across cities and villages in Goa to promote community health and well-being.
- Holds valid UAE driving license.
Certification
- 2021- CPC (ICD 10 CM) from AAPC-American Academy of Professional Coders, United States.
- Basic Life Support (BLS) from American heart Association (AHA) -DHCC
- Pursuing Certified Professional in Healthcare Quality (CPHQ)-NAHQ
Languages
English
Bilingual or Proficient (C2)
Hindi
Bilingual or Proficient (C2)
Arabic
Beginner (A1)
Marathi
Advanced (C1)
Konkani
Advanced (C1)
Malayalam
Advanced (C1)
Timeline
Pre- Authorization Officer
Abudhabi National Insurance Company (ADNIC)
04.2024 - Current
Approval Officer: Pre-Authorization
National Life & General Insurance, Inayah TPA
04.2022 - 03.2024
Ayurvedic Doctor
Mantra Ayurveda Clinic
08.2017 - 09.2018
Senior Wellness Consultant
Sanda Retreats, Goa
03.2013 - 04.2017
Resident Medical Officer
V.M Salgaoncar Hospital
06.2011 - 03.2013
Bachelor of Ayurvedic Medicine & Surgery -
Goa University
Master - Business administration- Healthcare services
Sikkim Manipal University
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