Summary
Overview
Work History
Education
Skills
Certification
Languages
Declaration
Timeline
Generic
Jils Jose

Jils Jose

Dubai

Summary

  • AAPC Certified Medical Coder with total of 10 years of experience in Outpatient claim Resubmission, Outpatient Coding 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
1
1
Certification

Work History

Medical Coder (Resubmission)

Gargash Hospital
10.2024 - Current


  • Review full medical documentation, including authorizations, diagnostic reports, referrals and injection codes to ensure accurate claim re-submission.
  • Investigate claim rejections to determine underlying issues and executed necessary corrections to ensure successful resubmission.
  • Monitor trends in denials/rejections to proactively prevent future errors and enhance submission quality.
  • Participate in the final reconciliation process with various insurance companies.
  • Responsible for assignment ICD-10-CM, CPT, Dental codes in accordance with current coding guidelines.
  • Ensure timely re-submission of rejected claims for prompt reimbursement.
  • Prepare a daily log of claims awaiting processing.
  • Maintain up-to-date knowledge of coding changes, payer rules and billing practices.
  • Contact insurance providers to clarify exact rejection reasons and ensure accurate claim resubmission with justification.
  • Prepare and share the monthly medical rejection report with doctors.
  • Generate a weekly resubmission and remittance report to monitor the status of claim resubmissions and highlight any missed resubmission.

Quality Assurance Officer

CCRCM
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
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
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.
  • 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
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
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

General Nursing -

Patanjali School of Nursing

Medical Coder - Medical Coding

M-Squared Training Center

Skills

  • Overseeing process flow to ensure clean claims and minimize rejections
  • Claim 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, Pivot table and V lookup
  • Utilized SAP, Insta, Mediware, CRS, Unite and Medas, software to mange and ensure accuracy in claim submission

Certification

1) AAPC Approved Certified Outpatient Coder (COC) (AAPC Membership number-01341154).

2) AAPC Approved Certification in ICD 10-CM Proficiency Assessment.

Languages

English
Advanced
Malayalam
Bilingual or Proficient (C2)
Hindi
Elementary (A2)
Tamil
Elementary (A2)

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, UAE.

Timeline

Medical Coder (Resubmission)

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

General Nursing -

Patanjali School of Nursing
Jils Jose