YASASII
Jayalakshmi Gajendran
Dubai
Summary
Accomplished and certified healthcare compliance specialist and inpatient coder with over 5 years of progressive experience in medical coding, revenue cycle management, and regulatory compliance. Highly proficient in ICD-10-CM/PCS, CPT, and HCPCS Level II coding, with specialized knowledge in IPDRG, MS-DRG assignment, and UAE healthcare regulations, including HAAD, DOH, and HIPAA compliance.
Possesses in-depth expertise in long-term care coding challenges, including chronic care management, MDS documentation, and SNF (Skilled Nursing Facility) coding. Demonstrates a strong grasp of medical terminology, anatomy and physiology, and insurance claim processing in both the U.S. and UAE contexts.
Experienced Dental Coder with comprehensive knowledge of ICD-10-CM, CDT, and CPT coding systems. Skilled in accurately translating dental diagnoses and procedures into standardized codes for billing and insurance claims.
A strategic leader with a proven track record in team leadership, conflict resolution, and operational planning. Skilled in denial management, EHR systems, and ensuring accurate and timely code assignment for optimal reimbursement and compliance. Known for integrity, attention to detail, and a commitment to improving healthcare operations through efficient claims handling and adherence to payer-specific guidelines.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Submission/Resubmission Officer - Coding
Aster DM Healthcare
10.2024 - Current
- Analyzed and optimized end-to-end coding processes, significantly improving coding efficiency, accuracy , and compliance across inpatient and outpatient services.
- Reviewed and managed eligibility, authorization, coding, and claim submission processes, ensuring proper documentation and timely reimbursements.
- Conducted thorough claims evaluations to ensure consistency between physician documentation and services provided, minimizing audit risks and denials.
- Managed long-term care coding workflows , streamlining insurance coordination and documentation processes to meet payer and regulatory requirements.
- Regularly analyzed denial codes and trends to identify root causes, implemented corrective actions, and reduced claim rejections and turnaround times (TAT) .
- Mentored and supported team members, helping them complete tasks on time , and communicated upcoming rejection trends and solutions to enhance team performance.
- Maintained strict adherence to HIPAA , HAAD , and DOH guidelines in the handling of patient records and documentation.
- Developed and tracked coding quality metrics , resulting in a measurable reduction in error rates and increased compliance with payer-specific and regulatory coding standards.
Subjective Matter Expert - Coding
Eclat Healthcare
09.2023 - 08.2024
- Applied official coding conventions and guidelines from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) to accurately assign diagnostic and procedure codes.
- Reviewed and appealed insurance denials by auditing patient records and verifying the accuracy of CPT, HCPCS, ICD-10-CM, and ICD-10-PCS codes to ensure appropriate reimbursement.
- Demonstrated proficiency in multiple coding systems , including CPT, HCPCS Level II, ICD-10-CM, and ICD-10-PCS, while maintaining active certification as an Inpatient Coder.
- Served as a subject matter expert (SME) on inpatient coding, providing guidance to internal departments on code assignment, documentation standards, and regulatory compliance.
Quality Auditor
Medvance Healthcare
03.2022 - 09.2023
- Proficient in LTC Coding
- Coding inpatient charts with accurate E/M and ICD-10-CM/PCS codes
- Auditing interventional cardiology and cardiac surgery claims
- Skilled in Same Day Surgery (SDS) and ambulatory surgery coding
- Staying current with AHIMA/HAAD clinical coding policies and healthcare requirements
- Identifying and correcting back-end coding errors and resolving system edits
- Performing patient record audits and documentation quality reviews
- Extensive use of 3M and encoder software to compute codes for inpatient records and code outpatient visits
- Conducting detailed claims reviews based on physician documentation and services rendered
- Managing the full cycle of authorization, coding, submission, and resubmission of claims
Senior Coding Officer
Miramed Ajuba Solutions
03.2017 - 03.2022
- Specialized in Outpatient (OP) Evaluation & Management (E&M) coding, with focused experience in Diagnostic Cardiology , Cardiothoracic Surgery , Interventional Cardiology , Same Day Surgery (SDS) , CDT , Anesthesia , and Pain Management coding.
- Expert in reconciling clinical notes , patient encounter forms , and health records to ensure documentation aligns with HIPAA , HAAD/DOH , and organizational compliance standards.
- Review and analyze billing and coding workflows to improve data accuracy and enhance Medicare and payer compliance , ensuring correct reimbursements and reducing audit risks.
- Identify gaps and inconsistencies in documentation and work cross-functionally with providers to correct them pre-billing, reducing delays and increasing first-pass claim acceptance.
- Ensure comprehensive understanding and application of E&M guidelines , specialty-specific coding practices , and regulatory standards to maintain billing integrity and maximize revenue.
- Coordinated operations with other emergency service groups.
Senior Medical Coder
Cognizant Technology Solutions, CTS
02.2011 - 05.2014
- 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
- Verified signatures and checked medical charts for accuracy and completion.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
Junior Medical Coding Officer
Serco Global Services
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
Master of Science - Biochemistry
Bharathi Women's College
Chennai, India05-2007
Bachelor of Science - Biochemistry
Bhartahi Women's College
Chennai, India05-2005
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
Software
POWERCHART
MS Office
EPIC & 3M
Cerner
IDX & Edits
Certification
- CCS
- CPC
- Lean six sigma Black Belt
- Certified ISO Internal Auditor
Timeline
Submission/Resubmission Officer - Coding
Aster DM Healthcare
10.2024 - Current
Subjective Matter Expert - Coding
Eclat Healthcare
09.2023 - 08.2024
Quality Auditor
Medvance Healthcare
03.2022 - 09.2023
Senior Coding Officer
Miramed Ajuba Solutions
03.2017 - 03.2022
Senior Medical Coder
Cognizant Technology Solutions, CTS
02.2011 - 05.2014
Junior Medical Coding Officer
Serco Global Services
03.2010 - 02.2011
Master of Science - Biochemistry
Bharathi Women's College
Bachelor of Science - Biochemistry
Bhartahi Women's College
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