Jayalakshmi Gajendran
Dubai,UAE
Summary
Accomplished healthcare compliance specialist with expertise in medical terminology, CPT coding, ICD-10-CM, and HCPCS Level II. Demonstrates proficiency in anatomy and physiology, insurance claim processing, and UAE insurance regulations. Skilled in navigating HIPAA, DOH & HAAD regulations and adept at denial management. Committed to enhancing healthcare operations through meticulous attention to regulatory standards and efficient claims handling.
Overview
15
15
years of professional experience
5
5
years of post-secondary education
Work History
Submission/Resubmission Officer
ASTER DM LLC
Dubai, UAE
10.2024 - 02.2025
- Analyzed and optimized coding processes, improving efficiency and accuracy
- Reviewing eligibility, Authorization, Coding, and Submission
- Evaluated claims to ensure alignment with physician documentation and services
- Managed long-term care processes, streamlining insurance coordination efforts
- Meeting physicians and medical staffs for medical necessity documentation Queries
- Analyze the denial codes and reduce the rejections. • Help the team mates in completing the tasks on time
- Reduce the TAT and denials - Communicate with team about upcoming new rejections and methods to reduce them.
- Maintaining the patients records as per HIPAA AND DOH/HAAD rules
- Developed coding quality metrics, significantly reducing error rates and enhancing compliance
Coding Specialist
ECLAT HEALTH SOLUTIONS
Hyderabad
09.2023 - 08.2024
- Applied official coding conventions and rules from American Medical association and Centre's for Medicare and Medicaid Services to assign diagnostic codes
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement
- Demonstrated expertise in various code sets including CPT, HCPCS Level II, ICD-10-CM and ICD-10-PCS codes while maintaining certification as an Inpatient Coder
- Acted as a subject matter expert on inpatient coding by consulting with other departments within the organization on code assignments and documentation requirements.
Medical Coding Auditor
MEDVANCE PVT LTD
Chennai
03.2022 - 08.2023
- Coding Inpatient charts with proper E/M codes & ICD codes
- Auditing Interventional Cardiology and Cardio surgery Claims
- Experienced in SDS and Ambulatory surgery coding process
- Maintaining abreast of clinical coding policies according to AHIMA/HAAD healthcare requirements
- Correcting back-end errors and resolving edits
- Worked on patient record audits and documentation quality checks
- Extensive use of 3M and encoder software to compute IR-DRG to code all Inpatient records & to code Outpatient Visits
- Claims Review - Evaluating the claims based on the physician documentation & services provided to the patients
- Handling Authorization, Coding, Submission & Resubmission
Senior Medical Coder
COGNIZANT TECHNOLOGY SOLUTIONS
Chennai
03.2017 - 03.2022
- Working in OP E&M, Diagnostic cardiology, Cardio Surgery, Interventional Cardiology, SDS, Anesthesia and Pain management
- Reconcile clinical notes, patient encounter form, health information for compliance with HIPPA rules
- Provide coding and documentation advice to the coding unit, clinical and professional staff
- Analyze billing to improve coding data accuracy for Medicare compliance reimbursement
- Ensure coded data accurately reflects service provided, based on documentation guarding against fraud and abuse
Senior Medical Coder
MIRAMED AJUBA SOLUTIONS
Chennai
02.2011 - 06.2014
- Worked in ED Profee
- Assure the assignment of complete, accurate, timely and consistent codes by the medical coding unit
- Provide coding and documentation advice to the coding unit, clinical and professional staff
- Analyse billing to improve coding data accuracy for Medicare compliance reimbursement
- Ensure coded data accurately reflects service provided, based on documentation guarding against fraud and abuse
Junior Process Executive
SERCO GLOBAL SOLUTIONS
Chennai
03.2010 - 02.2011
- Review and abstract relevant clinical data/medical records to select and sequence the appropriate ICD-9-CM diagnosis
- Extensive use of Encoder pro
- Tutors' new coders for compliance with ICD
- Self-Auditing the coded documents for quality purpose
Education
Bachelor of Science - Biochemistry
Bharathi Women's college
04.2002 - 05.2005
Master of Science - Biochemistry
Bharathi Womens College
06.2005 - 04.2007
Skills
- HEALTHCARE COMPLIANCE
- MEDICAL TERMINOLOGY
- CPT CODING
- ICD-10-CM
- HCPCS LEVEL II
- ANATOMY AND PHYSIOLOGY
- INSURANCE CLAIM PROCESSING
- UAE INSURANCE REGULATIONS
- HIPAA, DOH & HAAD REGULATIONS
- DENIAL MANAGEMENT
Timeline
Submission/Resubmission Officer
ASTER DM LLC
10.2024 - 02.2025
Coding Specialist
ECLAT HEALTH SOLUTIONS
09.2023 - 08.2024
Medical Coding Auditor
MEDVANCE PVT LTD
03.2022 - 08.2023
Senior Medical Coder
COGNIZANT TECHNOLOGY SOLUTIONS
03.2017 - 03.2022
Senior Medical Coder
MIRAMED AJUBA SOLUTIONS
02.2011 - 06.2014
Junior Process Executive
SERCO GLOBAL SOLUTIONS
03.2010 - 02.2011
Master of Science - Biochemistry
Bharathi Womens College
06.2005 - 04.2007
Bachelor of Science - Biochemistry
Bharathi Women's college
04.2002 - 05.2005
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