JAMES JAVIER
Abu Dhabi
Summary
Detail-oriented and certified Medical Coder with more than 10 years of experience in translating complex medical documentation into accurate and comprehensive codes. Proficient in ICD-10, CPT, and HCPCS coding systems, with a strong track record of ensuring precise coding, optimizing reimbursement processes, and maintaining compliance with regulatory standards. Demonstrated expertise in analyzing medical records, resolving coding discrepancies, and collaborating with healthcare providers to enhance documentation accuracy. Adept at leveraging coding software and electronic health record (EHR) systems to streamline workflows and support efficient claims processing. Committed to continuous professional development and staying current with industry changes to deliver high-quality coding services.
Overview
12
12
years of professional experience
1
1
Certification
Work History
CLINICAL CODER (SEHA-AmbulatoryHealthcareServices)
Talent One LLC
07.2024 - Current
- Review patient charts, medical records, and other documentation to assign the correct ICD, CPT, and HCPCS codes.
- Process a minimum of 175 claims a day conforming to ICD-10 and CPT-4 standards.
- Ensure that medical documentation is complete and accurate to support the codes assigned. Address any discrepancies or missing information with healthcare providers.
- Queries for coding clarifications that may impact documentation and proper reporting of diagnoses and/or procedures.
- Reviews claim data to ensure that assigned codes meet required legal and insurance rules are in place prior to submission.
- Review and analyze denied claims for resubmission to health insurance companies.
- Communicates documentation and claim deficiencies to appropriate departments (e.g. PAS, Clinical Team)
CLINICAL CODER (SEHA-AmbulatoryHealthcareServices)
Middle East Health Information Management Services LLC
09.2015 - 06.2024
- Review patient charts, medical records, and other documentation to assign the correct ICD, CPT, and HCPCS codes.
- Process a minimum of 175 claims a day conforming to ICD-10 and CPT-4 standards.
- Ensure that medical documentation is complete and accurate to support the codes assigned. Address any discrepancies or missing information with healthcare providers.
- Queries for coding clarifications that may impact documentation and proper reporting of diagnoses and/or procedures.
- Reviews claim data to ensure that assigned codes meet required legal and insurance rules are in place prior to submission.
- Review and analyze denied claims for resubmission to health insurance companies.
- Communicates documentation and claim deficiencies to appropriate departments (e.g. PAS, Clinical Team)
Certified Medical Coder
United Health Group Philippines
06.2012 - 09.2015
- Assigns codes (ICD-9-CM, CPT, and HCPCS) appropriately to diagnosis and procedures abstracted from the medical record (Inpatient, Emergency Records, Office Visits and Ancillary Services)
- Proficient in abstracting the information needed from patient's records while maintaining patient's confidentiality
- Handles protected health information based on established protocols
Education
Bachelor of Science - Nursing
Philippine Women's University
Philippines09.2009
Skills
- Medical Coding Proficiency
- Clinical Knowledge
- Great familiarity of Health Abu Dhabi Coding and Billing Guidelines
- Attention to Detail
- Analytical Thinking and Problem Solving
- Effective Communication
- Collaboration and Teamwork
- Proficiency in Microsoft Word, Excel, and PowerPoint for documentation and reporting purposes
- Excellent oral and written skills in communication
Professionalcompetencies
- Adept in utilizing coding applications such as CERNER, Citrix, 3M Encoder
- Adept in utilizing MS OFFICE (Excel, Word, PowerPoint)
- In depth knowledge of coding concepts and principles
- Great familiarity of Health Abu Dhabi Coding and Billing Guidelines
- Thorough understanding of medical coding and business systems
- Able to adopt, modify and prioritize coding functions
- Track record of analyzing and translating medical and clinical diagnosis, procedures and designated numerical codes
- Excellent oral and written skills in communication
Educationalcompetencies
Bachelor of Science in Nursing, Philippine Women's University, Manila, 06/01/06, 09/12/09
Personal Information
- Age: 35
- Date of Birth: 07/25/89
- Nationality: Filipino
- Marital Status: Married
Affirmation
I affirm that the above information is true and correct.
References
Available upon request.
Certification
• Certified Professional Coder AAPC Credentialed (2012)
• Registered Nurse Philippines (2010)
Timeline
CLINICAL CODER (SEHA-AmbulatoryHealthcareServices)
Talent One LLC
07.2024 - Current
CLINICAL CODER (SEHA-AmbulatoryHealthcareServices)
Middle East Health Information Management Services LLC
09.2015 - 06.2024
Certified Medical Coder
United Health Group Philippines
06.2012 - 09.2015
Bachelor of Science - Nursing
Philippine Women's University
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