JIJI RAJAN

A committed and highly competent professional, Nurse with CPC certification, equipped with 10 years of experience in vivid aspects of the medical field and revenue cycle management such as authorization, medical coding, submission and resubmission, medical billing, and administration in key roles. Currently working as Approvals Officer at Nmc Speciality Hospital, Abu Dhabi, managing authorization team and monitoring day-to-day operations and preparing reports of daily activity as requested for management and assists management in monthly reports as requested. Highly experienced in dealing with all insurance companies in UAE. Excellent knowledge in handling Medical claims. Apply medical knowledge and best insurance practices while reviewing and verifying the pre-approval requests received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details of the Pre-Authorization Requests are in line with the regulators' standards, especially the claim adjudication Rules and Business Rules. Handling the rejected pre-authorization and getting required justification from the treating doctor to resend it to Insurance company and obtain the approval. Monitor and analyze rejections rates and denial reasons, perform a claim review according to medical necessity and prepare the rejected claims for the resubmission process. Supports Continuous Quality Improvement and participates and contributes to all the quality assurance activities of the service. Confident, self-motivated, and easily adaptable to new systems and circumstances. Good leadership skills and highly enthusiastic in taking initiative Trained to work in a professional and systematic environment. Interactive with people and a good team player who is learning from others and imparting knowledge to others.