Savitha Rajakumar

• Manager
• Kanad hospital , outsourced to UMED company Abu Dhabi and Alain
• More than 1400 staffs , comprising of over 100 doctors ( 50 % US doctors and multinational ) and multispecialty hospital focusing on NICU , women and child facility,
• Work process :
• Leading Team of auditors and coders
• RCM audits on the concurrent and retrospective claims OP, IP, ER, DAYCASE claims
• Clinical documentation improvement , findings will be communicated to respective stake holders .over the meetings and training with CMO, HOD s, physicians , nurses , receptionists, cashier, therapist and allied health staffs
• Errors on the HIM will be communicated to the IT department with examples and work up correction to be followed
• Audits findings on the RCM coding daily will be communicated and training on the errors will be followed
• CDI process of audits , training , follow-up and monitor
• Participate in Jawda and Tasneef audits
• Updating the CEO , COO and CMO weekly , biweekly meetings and monthly audit reports presentation and discussion
• Revenue reports , denial analysis and trends in the missing procedures is process started
• Learned new skills and applied to daily tasks to improve efficiency and productivity.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Demonstrated respect, friendliness and willingness to help wherever needed.
• Proved successful working within tight deadlines and fast-paced atmosphere.
• Carried out day-to-day duties accurately and efficiently.
• Participated in team-building activities to enhance working relationships.

• No contract was established as mistake by the HR , I am on spouse visa and EID )
• Duties :
• Communicating to the team and analyst
• Feedback to all insurance companies and stake holders of the provider
• Handling over 50 provider claims – IP , OP, ER and ABM –covid claims on resubmission Training all the relevant doctors , coders , biller and other stake holders as per the adijucation rules and guidelines
• Reports analysis and updating the director and CEO RCM on timely bases , in all the meetings
• Maintained energy and enthusiasm in fast-paced environment.
• Used Microsoft Word and other software tools to create documents and other communications.
• Resolved problems, improved operations and provided exceptional service.
• Collaborated with team members to achieve target results.

• JCI Accredited and ISO std 50 bedded multispecialty hospital , 350staff size, 60 physicians , 4 OT s, polyclinic Pharmacy , 2 laboratory and 2 radiology
• Departments
• Reporting to CEO and management directly
• Handling the day today operations and staff Claims , pre approval , coding, billing , submission , resubmissions ,reconciliations
• Contracts and network with payers , pricing and price revision as per SPC
• Denial analysis and rejection feedback training to physicians and nurses
• IP admissions and discharge criteria as per coding and billing
• OP claims coverage and exclusion as per each insurance company
• Staff training and department meeting and updates as per DOH and insurance companies PPT presentation training for levels of staff
• Clinical documentation analysis and deficiency correction
• Feedback to management and reports monthly Weekly
• Contracts for hospital , lab and pharmacy with all insurance companies and TPAs
• Insurance relationship management Operations meeting
• Management meeting Medical records meeting
• IT department updates as per DOH for RCM and Insurance requirement
• Revenue report
• Consolidated reports to CEO and CFO Physician wise revenue report for the analysis and plan accordingly
• Data owners for all the KPIs
• Member in medical council : presenting the data analysis to the management
• Member in medical records presenting the deficiency and errors corrections and documentation audit feedback
• Operations meetings representing insurance and coding department updates and requirements the IT
• Handling the master price list and fixing as per the SPC contracts management in operations meeting companies for all concerns from provider
• Communicating to all insurance companies regarding the issues , pending , claims , resubmissions
• Al licensed doctors and staff updating to all insurance companies as per DOH trainings , sharing MOM to HR dept and management
• On clinical documentation Medical necessary and rejection of Claims
• Training and orientation for new physician and staffs related to EMR/RCM of the patient plans
• Daily Operation , process of IP approval , audit ,coding , billing , and submission .
• Learned new skills and applied to daily tasks to improve efficiency and productivity.

• Avivo group of hospitals Abu Dhabi units, National hospital
• NNMC prima clinics and branch
• Rima pharmacy
• NNMC pharmacy
• In charge of Complete RCM process
• Monitoring and reporting daily submission , preapprovals, resubmission, coding ; updating on daily collections and receivables
• Reporting to CEO directly in the HODs and management meeting
• Communicating to all insurance companies regarding the issues , pending , claims , resubmissions
• Training doctors
• On clinical documentation Medical necessary
• Denial analysis and management
• Training front office staff demographic of the patient insurance cards details and network plans, Preparing flow chart , work flow according to the depts
• Concerned in the hospital as per DHA
• Handling complete insurance and operation in the hospital , concerning the finance and insurance
• Reporting to the MD directly
• Presentation in the management meetings
• Training doctors, front office and nurses in charge in OPD , OT and IP wards for all insurance protocols
• Factors and discounts negotiations
• Pricing and matrix preparation according to DHA and DOH guidelines
• Revision of prices on annual bases
• Communicating to all payers and TPAs as per the requirement of clients (hospitals and medical centers)
• Co ordinating with resubmission team and reconciliation team for claims maximum benefits
• Analysis and feedback to the clients and the management accordingly
• Drove operational improvements which resulted in savings and improved profit margins.
• Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
• Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
• Used Microsoft Word and other software tools to create documents and other communications.

· Preparing flow chart , work flow according to the depts. Concerned in the hospital as per DHA

· Handling complete insurance and operation in the hospital , concerning the finance and insurance

· Reporting to the MD directly

· Presentation in the management meetings

Payer relationship manager - pricing and contracting and Insurance

Handling 28 hospitals and medical centers in UAE

Dubai , Abu Dhabi , Sharjah and Ajman for networks

· Factors and discounts negotiations

· Pricing and matrix preparation according to DHA and DOH guidelines

· Revision of prices on annual bases

· Communicating to all payers and TPAs as per the requirement of clients (hospitals and medical centers)

· Co ordinating with resubmission team and reconciliation team for claims maximum benefits.

Analysis and feedback to the clients and the management accordingly

• Created plans and communicated deadlines to complete projects on time.
• Demonstrated respect, friendliness and willingness to help wherever needed.
• Conducted research, gathered information from multiple sources and presented results.

• Complete insurance companies /TPAs network factors negotiation and establishing contracts – achieved 23 insurance companies and TPAs
• In charge of Revenue cycle management
• Worked on new Hospital information system completely on Insurance module, Billing, invoices, medical records and achieved the best results, continuous training and updating new staff in team and doctors
• Onboarding RCM staff interviews and training
• Auditing and clinical Documentation
• Auditing-out patient dept claims /Day care cases/DRGs in Burjeel hospitals
• Generating XML files, uploading in DOH website Green rain, submission of claims, download and feedback reports to Finance Manager, Managing Director and CEO
• Resubmission of claims and denial management according
• Training for doctors on E and M evaluation, ICD 9 codes, CPT 4 codes for the procedures
• Outpatient and Inpatient approvals from the insurance companies
• Through email , fax , website portal s
• Clients from the THIQA, DAMAN, ADNIC, NAS , AXA, NGI AMITY, DUBAI INS , NEXTCARE & other Insurance co s in Dubai and Abu Dhabi
• Maintaining healthy relationship with all the payers and TPAS for 9 + yrs
• Updating the HAAD ( DOH ) drug list
• Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
• Established and checked coding procedures, monitored reports and updated internal files.

• ( currently named as Mediclinic group of hospitals )
• Denial analysis and management, clinical Auditing and Documentation
• Re submission unit , Insurance and RCM department
• JOB RESPONSIBILITIES
• Denial analysis done branch wise through the e claims and rejection, feedback to the RCM director and manager and training doctors , insurance staff , front office staff accordingly
• And update about the insurance companies
• Mussafah and western region
• Lately started for Airport and Khalifa branch also
• Training and feedback through the Power point presentation and data through the graphs and samples of each denial from the branches
• Auditing-out patient dept claims , clinical documentation on daily basis
• Auditing In patient files and claims on daily discharge basis in Al Noor Group of Hospitals
• Working in compliance with DAMAN, ADNIC, ALICO, NAS, Al DHAFRA, NGI and other insurance companies patients which are acceptable in Al Noor Hospital group
• Resubmission unit- Corporate level ( six branches , Denial Management
• Resubmitting and supervising the claims, training new joiners – Al Noor branch wise, insurance company wise
• Al Noor Hospital is one of the largest private health care providers in Abu Dhabi, UAE
• It is a JCI accredited group of hospitals with six branches in various places in Abu Dhabi, Al Ain and western region.

• Ahalia Hospital is one of the major private healthcare network in Abu Dhabi UAE ( JCI accredited) having many hospitals, satellite medical centers( 11 in number .) and 18 pharmacies all over Abu Dhabi and Al Ain
• Coordinating with all major medical Insurance companies – DAMAN, ALICO, NAS , Oman Insurance NEXTCARE, ADNIC, AL Dhafra , AL Khazna etc
• Training - CREs, Doctors and new staff in ICD and CPT coding
• Interviewing panel for the post of coders and Insurance coordinators
• Having sound knowledge and expertise in obtaining approvals in Cardiology, Gynecology Int
• Medicine ENT , Ophthalmology, Gen.Surgery , Orthopedic, Dental & Urology- for all the concerned outpatient and Inpatient procedures and investigations in these specialties both elective and emergency.
• Worked on and trained group wise for JCI- FORMALITIES PROCEDURES IN THE HOSPITAL
• Achieved the same, JCI-2010.Ahalia hospital
• Co-coordinating with the reconciliation team and giving the feed back to the doctors and all concerned through training program
• Duty roster for staff
• Training and guiding with the pharmacy approvals and reconciliation
• Taking rounds to all the counters- checking for OP, IP approvals, Medical reports , pending Taking verbal approvals
• Weekly Dept Training with all insurance coordinators and resubmission team

• NMC Hospital is one of the largest Private health care institutions in Abu Dhabi, UAE dealing with all Major medical Insurance providers like DAMAN, ALICO, OMAN Insurance, NAS, NEXTCARE, ADNIC, Al Dhafra etc to name a few
• JOB responsibilities
• Assessing and analyzing the approvals
• Verifying the approvals and the attached documents
• Coordinating with all the Insurance companies , Through telephone, faxes and emails
• Communicating with the insurance providers, institution, doctors and patients whenever and wherever required in a professional and ethical way
• Documenting the processes , Providing excellent customer service
• Claim checking & processing

· Working as an Insurance consultant & Networking with American Life Insurance company (ALICO) in Dubai, UAE since Apr,2006 till May 2008 having good experience in Networking.

Dealing with Individual and Group medical insurances, Accident coverage.- co-ordination and claims.

· Served in the field of network dept, ALICO.

· Training staff in Medical products, telemarketing skills, Networking skills

• Finalized sales and collected necessary deposits.
• Collected, analyzed and validated agency commissions.
• Utilized direct marketing strategies such as mailings and phone contracts to approach potential clients and increase sales
• Calculated premiums and established payment methods for sales.
• Collected premiums on or before effective date of coverage.
• Improved operations through consistent hard work and dedication.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.

• Having good experience in Networking
• Dealing with Individual and Group medical insurances, Accident coverage.- co-ordination and claims
• Served in the field of network dept, ALICO
• Training staff in Medical products, telemarketing skills, Networking skills
• Met with customers to provide information about available products and policies.
• Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
• Participated in team-building activities to enhance working relationships.

• Assessed marketing copy, art comps and final designs and compared with established specifications.
• Managed workflow between staff, coordinating documents and creative material distribution.
• Maintained complete database of files, contacts and project materials.
• Maintained documentation, detailing assignments, in-progress work and completed project milestones.
• Assisted in all dental procedures done in the clinic

• Assisting the Dentist in all dental procedures
• Completed consultations with patients for treatment plan.
• Supported patient comfort with calm demeanor and individualized pain management.
• Assisted in Extracted teeth, performed root canals and filled cavities with dedication to pain management.
• Assisted in root canal procedures to treat nerve and dental pulp issues and prevent further damage to teeth and gums.
• Advised patients on appropriate treatment for pain and gave specific home care instructions.
• Reviewed patient health history and performed checkups to assess current issues.
• Defined and enforced dental office policies and procedures.

• Performed general chair-side duties for general dentistry, endo procedures and oral surgery.
• Educated patients by giving oral hygiene, plaque control and postoperative instructions.
• Assisted dentists by passing instruments, suctioning intraoral fluids, adding water and mixing materials for fillings, [Type], casts and impressions.
• Staged tray for procedures by arranging dental instruments and equipment.
• Managed office schedules and calendars to coordinate administrative planning and execution.
• Took dental images following strict patient protection rules, applying lead aprons.
• Educated patients on postoperative care and best practices for protecting dental work and boosting healing process.
• Educated patients on dental hygiene, pre-surgical instructions and post-surgical care.
• Explained treatment procedures and instructed patients on home care guidelines.
• Sanitized trays, instruments and surfaces for clean dental office setting and patient safety.
• Maintained dental supply inventory by checking stock to determine inventory levels and placing and expediting orders for supplies.
• Successfully assisted dentist by performing four-handed dentistry and other chair-side duties.
• Assisted dentist with paperwork and billing protocol for both routine and less common procedures.
• Prepared and arranged instruments, medications and required materials for dental procedures.

• Provided emergency surgeries for patients with broken teeth or facial bones, prioritizing both functionality and aesthetics during treatments.
• Removed wisdom teeth and performed root canals.
• Closely monitored patient comfort during treatments, adjusting tools and medications to uphold best-in-class comfort standards.
• Created individualized treatment plans to maintain or restore oral health of patients.
• Used rotary and dental appliances and surgical implements to clean, fill, extract and replace teeth.
• Performed root canal procedures to treat nerve and dental pulp issues and prevent further damage to teeth and gums.
• Treated infections of oral cavity, salivary glands, jaw, face and neck.
• Prescribed medication to improve recovery and control pain after procedures.
• Conducted thorough patient examinations while screening for jaw and tongue cancers by inspecting teeth and soft oral tissues.
• Reviewed patient health history and performed checkups to assess current issues.
• Provided instruction on diet, brushing, flossing and other aspects of oral health to patients.
• Evaluated patient dental conditions and gave advice on best options for treatment plans based on patient needs and desires.
• Administered anesthetics and sedatives to control patients' pain and reduce stress for anxious patients during procedures.
• Communicated one-on-one with patients during consultative appointments to explain treatment plan and educate on upcoming procedures.
• Performed surgical procedures to extract impacted or damaged teeth, place dental implants and remove tumors and other abnormal growths.
• Consulted with patients and analyzed patient data to determine patient needs and treatment goals.

• Provided emergency surgeries for patients with broken teeth or facial bones, prioritizing both functionality and aesthetics during treatments.
• Communicated with insurance agencies about treatment options for individuals and accurately relayed information to patients.
• Conducted research on defects, diseases and disorders affecting oral and facial regions.
• Removed wisdom teeth and performed root canals.
• conducted dental camps in schools
• conducted vaccination and blood donation camps in colloboration with Lions Club International, India
• Treated infections of oral cavity, salivary glands, jaw, face and neck.
• Conducted thorough patient examinations while screening for jaw and tongue cancers by inspecting teeth and soft oral tissues.
• Reviewed patient health history and performed checkups to assess current issues.
• Provided instruction on diet, brushing, flossing and other aspects of oral health to patients.
• Alleviated infections with debriding and surgical procedures.
• Communicated one-on-one with patients during consultative appointments to explain treatment plan and educate on upcoming procedures.
• Performed surgical procedures to extract impacted or damaged teeth, place dental implants and remove tumors and other abnormal growths.
• Consulted with patients and analyzed patient data to determine patient needs and treatment goals.
• Administered care in emergency situations to treat tooth injuries.

• Provided emergency surgeries for patients with broken teeth or facial bones, prioritizing both functionality and aesthetics during treatments.
• Closely monitored patient comfort during treatments, adjusting tools and medications to uphold best-in-class comfort standards.
• Created individualized treatment plans to maintain or restore oral health of patients.
• Performed root canal procedures to treat nerve and dental pulp issues and prevent further damage to teeth and gums.
• Treated infections of oral cavity, salivary glands, jaw, face and neck.
• Prescribed medication to improve recovery and control pain after procedures.
• Reviewed patient health history and performed checkups to assess current issues.
• Conducted thorough patient examinations while screening for jaw and tongue cancers by inspecting teeth and soft oral tissues.
• Provided instruction on diet, brushing, flossing and other aspects of oral health to patients.
• Alleviated infections with debriding and surgical procedures.
• Administered anesthetics and sedatives to control patients' pain and reduce stress for anxious patients during procedures.
• Removed impacted and non-restorable teeth, both during surgeries and day-to-day procedures.
• Removed wisdom teeth and performed root canals.