SANTHOSH MATHAIYAN BPT, CPC

Review patient records and physician documentation to accurately assign diagnosis and procedure codes for services rendered.

Ensure clinical coding accuracy to align with physician documentation and comply with insurance requirements.

Support preapproval processes to obtain correct approvals as per insurance policies.

Evaluate clinical documentation quality to identify and address inconsistencies affecting code selection for outpatient encounters.

Analyze and manage claim rejections, coordinating with responsible departments to develop effective resolution strategies.

Determine insurance policy coverage, including diagnosis, procedures, investigations, medications, patient responsibility, and authorization requirements.

Conduct training, audits, and feedback sessions for new team members to ensure coding and billing proficiency.

Collaborate with physicians, nurses, and insurance departments to improve documentation accuracy and minimize rejections.

Reduce denied claims by thoroughly verifying billing details before submission.

Stay updated on regulatory changes to ensure adherence to evolving legal requirements in medical billing and coding.

Lower rejection rates to single digits through compliance with coding guidelines and clinical documentation improvement initiatives for treating doctors and front-office staff.

Provide support to approval and front-office teams regarding CPT and ICD codes and their application.

Utilize CEED (Coding Edits Engine of Dubai) for medical necessity audits to enhance coding accuracy.

Upload claims to DHPO (XML format) and promptly resolve any XML errors when needed.

Reviewed and assigned accurate ICD and CPT codes based on patient records to ensure precise medical billing.

Coordinated with treating physicians to verify the completeness of patient documentation in compliance with coding guidelines.

Supported the insurance team by facilitating preapproval codes to secure necessary authorizations.

Collaborated with respective teams to minimize rejection rates, ensuring alignment with coding standards and DHA guidelines.

Assign appropriate ICD and CPT codes based on patient medical records to ensure accurate billing.

Coordinate with treating physicians to verify completeness of patient documentation in alignment with coding guidelines.

Support the insurance team in securing preapproval codes for authorization.

Submit claims through DHPO, ensuring compliance with regulatory requirements.

Assist the resubmission team by applying coding guidelines to justify claims and secure payment for rejected cases.

Collaborate with relevant teams to minimize rejection rates by adhering to coding standards and DHA guidelines

• Handled a team of 50 people in medical coding with multiple clients from US healthcare system
• Delivered within the TAT time in accordance with client expectation
• Review and provided proper feedback to the team based client feedback
• Handled pilot projects and succeeded to the client expectations
• Arranged and provided coding tools whenever it was needed with the support of service delivery manager
• Coordinated with service delivery manager for the betterment of process growth and improvement
• Randomly audited and provided the feedbacks to the team
• Had continuous meetings with stakeholders and clients regarding project update
• Received multiple start awards at regular intervals