Jils Jose
Sharjah,United Arab Emirates
Summary
- AAPC Certified Medical Coder with total of 9.7 years of experience in Outpatient claim submission, Outpatient Resubmission and Reconciliation. I aim to apply my deep understanding of coding guidelines and strong analytical abilities to streamline operations within your esteemed organization.
Overview
12
12
years of professional experience
4
4
years of post-secondary education
1
1
Certification
Work History
Outpatient Medical Coder/ Resubmission Officer
Gargash Hospital
Dubai, United Arab Emirates
10.2024 - Current
- Responsible for assignment ICD-10-CM, CPT, Dental codes in accordance with current coding guidelines.
- Ensure timely submission of claims for prompt reimbursement.
- Review entire medical record, Authorization details, Radiology, lab reports, referral letter and Injection codes.
- Prepare a daily log of claims awaiting processing.
- Ensure compliance with official coding guidelines and payer-specific requirements.
- Maintain up-to-date knowledge of coding changes, payer rules, and billing practices.
- Assist in identifying and correcting coding-related denials and supported claim resubmission processes.
- Reviewed and analyzed rejected or denied submissions to identify root causes and determine corrective actions.
- Monitored trends in denials/rejections to proactively prevent future errors and enhance submission quality.
- Ensured all resubmissions met regulatory and compliance standards specific to the industry.
- Participate in the final reconciliation process with various insurance companies.
Quality Assurance Officer
CCRCM
Abu Dhabi, United Arab Emirates
12.2023 - 09.2024
- Conducted audits for Outpatient medical records and coding data to ensure accuracy and compliance with regulations(DOH,DHA,Tasneef,ICD-10,CPT-4).
- Implemented quality improvement plans to address coding errors and improve coding accuracy.
- Maintained quality metrics and reports to measure coding performance.
- Stayed up to date with market consultation, changing regulation and implementing changes as needed.
- Prepared comprehensive Jawda audit data, ensuring accuracy and completeness for review and conducted thorough Jawda audit reviews based on published scores, meticulously analyzing grey areas to identify root causes of errors.
Resubmission Officer
NMC Healthcare
Sharjah, United Arab Emirates
01.2019 - 05.2022
- Review patient’s electronic medical records and paper claims to identify the specific reasons for rejections, then resubmit the claims with appropriate justifications and supporting documentation.
- Collaborate with physicians, nurses, and the submission team to address any deficiencies in medical records, ensuring comprehensive documentation to prevent future claim rejections.
- Participate in the final reconciliation process with various insurance companies.
- Oversee, manage, and monitor rejected claims to prevent large-scale rejections.
- Adhere to medical coding guidelines and the specific policies set by each Insurance company.
Outpatient Medical Coder
NMC Healthcare
Sharjah, United Arab Emirates
04.2015 - 12.2018
- Handle the daily processing of electronic and paper claims from registration to submission.
- Assign ICD-10-CM, CPT, DSL, CDT, and DDC codes for medical and dental procedures and services.
- Include valid approval copies, referral letters, and lab and radiology reports and submit the claim to DHPO.
- Proficiency in identifying medical necessity in patient records and addressing missing documentation.
- Verify patient insurance card eligibility, final approval, copay, coinsurance, deductibles, networks, and payer ID.
Medical Coder
E4E Healthcare Business Services
Chennai, India
06.2014 - 11.2014
- Review medical records and accurately assign appropriate codes.
- Reviewing each claim to ensure compliance with appropriate guidelines and procedures and Applying diagnostic and procedural codes to outpatient records using ICD-10-CM and CPT/HCPCS.
Medical Coder
Dell International Services
Chennai, India
05.2013 - 05.2014
- Review patient’s E-medical records and Ensure codes are sequenced in accordance with government and insurance company guidelines.
- Input CPT codes for procedures and other requested items as per patient request.
Education
Diploma in General Nursing & Midwifery - Healthcare
Patanjali School of Nursing
India 09.2006 - 02.2010
Medical Coder - Medical Coding
M-Squared Training Center
India 11.2012 - 03.2013
Skills
- Certified Outpatient Coder (COC) approved by AAPC (American Academy of Professional Coders)
- Overseeing process flow to ensure clean claims and minimize rejections
- Claim Creation, submission to Payer and Denial management of Claims
- Proficient in Insurance claim analysis, in Outpatient coding-claim management, Resubmission & Reconciliation
- Good knowledge of medical related rules and regulations
- Strict attention to details
- Knowledge of 3M coding and resolving all coding edits
- Good interpersonal skills and the ability to function as a team member
- Ability to keep confidentiality of information
- Proficient in computer like MS excel, PPT and V lookup
- Utilized SAP, Insta, Mediware, Unite and Medas, software to mange and ensure accuracy in claim submission
Languages
English
Advanced
Certification
1) AAPC Approved Certified Outpatient Coder (COC) (AAPC Membership number-01341154).
2) AAPC Approved Certification in ICD 10-CM Proficiency Assessment.
Declaration
I affirm that the information provided above is accurate and true to the best of my knowledge and belief.
Name: Jils Jose
Place: Sharjah
Timeline
Outpatient Medical Coder/ Resubmission Officer
Gargash Hospital
10.2024 - Current
Quality Assurance Officer
CCRCM
12.2023 - 09.2024
Resubmission Officer
NMC Healthcare
01.2019 - 05.2022
Outpatient Medical Coder
NMC Healthcare
04.2015 - 12.2018
Medical Coder
E4E Healthcare Business Services
06.2014 - 11.2014
Medical Coder
Dell International Services
05.2013 - 05.2014
Medical Coder - Medical Coding
M-Squared Training Center
11.2012 - 03.2013
Diploma in General Nursing & Midwifery - Healthcare
Patanjali School of Nursing
09.2006 - 02.2010
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