Summary
Overview
Work History
Education
Skills
Certification
Additional Information
Accomplishments
Affiliations
Software
Interests
Work Availability
Quote
Timeline
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Savitha Rajakumar

Savitha Rajakumar

HOD /SENIOR MANAGER–PROVIDER RELATIONS /INSURANCE /BUSINESS STRATERGY
Al Ain

Summary

A well-qualified doctor with and experience in dental and community practice in India and Dubai with hospitals, clinics and NGO s of well reputation in their respective field.

Carrying total work experience of 24 years with payer ALICO –AIG ( Metlife now ) and providers .

As practicing doctor and insurance sector ,in which I have 19 + years in UAE ,17 yrs in insurance sector , last 11 + yrs as manager , supervisor , HOD in Insurance and RCM , in corporate hospitals group , individual hospital and RCM billing management in Dubai and Abu Dhabi, AL Ain regions .


8 + yrs as manager in provider network relationship , contracts and network, ALICO AIG, Wellness one day surgery center ,Accumed and Emirates international hospital -HOD Complete insurance companies /TPAs network factors negotiation and establishing contracts – achieved 23 insurance companies and TPAs


I have vast experience as :Network manager , Denial analyst ,in reimbursement , reconciliation ,Insurance and claims operations, contracts, pricing , revenue cycle management ,clinical documentation improvement CDI ,quality auditing, training physicians , nurses, front office staffs and all RCM stakeholders .


I am well versed in all the work procedures of insurance companies and hospital procedures , lead for Jawda Tasneef audits , according to DOH and DHA guidelines and International accreditation standards .


I have a good rapport with all the payers -insurance companies for the past 17 + yrs . I have done my coding course and have vast experience on ICD 10 ; Cpt4 , E & M and DRG codes, Dental USCLS CODES .


I have done a hospital administration course from the UK , advance excel course , excellent in PPTs presentations of finance and business strategy ,contracts and network with payers , pricing and price revision as per SPC Quality assurance in health care US and UAE - CPHQ course .


Trained in sigma six green belt course UK accreditation –project management .


I have handled a team of 5 to 50 staff in Insurance and RCM department Comprising of pre-approval staff , network co ordinators , MIS analyst , coders , billers , auditors and insurance coordinator at the corporate levels of the largest private hospitals in Abu Dhabi , Al Ain and Dubai and RCM companies consisting of clinics and hospitals from Ajman , Sharjah , Dubai , Al Ain and Abu Dhabi .


Dr. Savitha Rajakumar 971553697336 ; 97150856132

Overview

24
24
years of professional experience
22
22
years of post-secondary education
4
4
Certifications
8
8
Language

Work History

Internal Audit and CDI Manager

UMED,Abudhabi/ kanad Hospital, AL Ain
Al Ain
06.2021 - Current
  • 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.

Resubmission Team Assistant Manager

• VPS claims care –Burjeel hospital , Medoer , Lifecare Dubai, Abudhabi, sharjah and AlAIN
Abudhabi
03.2021 - 05.2021
  • 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.

HoD , Senior Insurance and RCM Manager

Emirates International hospital group, Al Ain, UAE
Al Ain
07.2019 - 02.2021
  • 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.

RCM Manager

Avivo group of hospitals Abu Dhabi units
Abudhabi
03.2018 - 09.2018
  • 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.

Insurance / Onsite Operation Manager (project lead)

ACCUMED RCM solutions Dubai
Dubai
09.2016 - 01.2018

· 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.

Insurance Manager

Wellness One Day surgery Center
Abu Dhabi
08.2014 - 08.2016
  • 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.

Senior Medical Officer/Denial analyst

Al Noor Group of Hospitals(Mediclinic Middle east)
Abu Dhabi
10.2011 - 06.2014
  • ( 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.

Coordinator & In Charge ,Insurance Dep/Supervisor

Ahalia Hospital
Abu Dhabi
01.2010 - 07.2011
  • 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

Insurance coordinator

NMC Hospital
ABU DHABI
11.2008 - 08.2009


  • 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

Insurance consultant

ALICO
DUBAI
04.2006 - 05.2008

· 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.

Insurance Consultant & Networking With Group Insur

American Life Insurance company
Dubai
04.2006 - 05.2008
  • 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
  • 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.

ASST. DENTIST and Marketing manager

Ravari Dental Clinic
Dubai
05.2005 - 04.2006
  • 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

Assistant Dentist

German Dental Clinic
Dubai
10.2004 - 11.2004
  • 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.

Dental Assistant

Jebel Ali International Hospital
Dubai
08.2002 - 04.2003
  • 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.

Dental Surgeon

VAN ALLEN HOSPITAL
Kodaikanal
06.2001 - 06.2002


  • 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.

Dental Surgeon

CSI HOSPITAL
Erode
09.1998 - 05.2001
  • 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.

Dental Surgeon

Sara Dental clinic
Erode
09.1998 - 06.2001
  • 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.

Education

Professional Diploma - healthcare administration

University of Notting Hill

M.D Alternate - Medicine

Srilankan Open University

BDS - undefined

N.M.DENTAL COLLEGE& HOSPITAL KARNATAK UNIVERSITY
01.1993 - 01.1997

Complusory Rotatory Clinical Internship - Dentistry

P.M.N.M .DENTAL COLLEGE
Karnataka, India
08.1997 - 08.1998

MS Word , MS Excel And Power Point Presentation - Microsoft Office

Dubai Cultural & Scientific Institute
Dubai, UAE
11.2003 - 12.2003

Certification in DRG & E & M Coding - Coding

Department of Health
Abudhabi, UAE
08.2010 - 08.2010

Training For CCA – Certified Coding Associate - Coding

Acorn Research ( Accredited By DHA,UAE)
Abudhabi,UAE
07.2013 - 07.2013

CPHQ Training in Professional Healthcare Quality Abu Dhabi - Healthcare Quality Management

Professional Healthcare Quality
Abudhabi, UAE
08.2016 - 08.2016

No Degree - Advanced Excel Functions , Format Painting ,

Aims Training Center
Abu Dhabi
04.2001 -

SIX SIGMA GREEN BELT -

SIX SIGMA GREEN BELT
UAE
03.2021 - 04.2021

Skills

Proficient in English ( IELTS Band 7, speaking Score 8 ;undefined

Certification

in telephonic -. communication skills

Additional Information

  • Driving License Holding Valid UAE driving license with clean report for 18 + yrs.
  • 8 + yrs as manager in provider network relationship , contracts and network, ALICO AIG, Wellness one day surgery center ,Accumed and Emirates international hospital -HOD Complete insurance companies /TPAs network factors negotiation and establishing contracts – achieved 23 insurance companies and TPAs In charge of Revenue cycle management 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) pricing and price revision as per SPC Registration with Dubai Health Authority And Indian Dental Council Leading Revenue Cycle Management and Insurance Team - Responsible for timely claims submission, re submission and financial settlement with reconciliation with all contracted insurance companies. Leading team of coders, billing, medical auditors, claim processors and others supporting staff for smooth operations of the company. Develop strategic plans and programs for the Revenue Cycle team and ensure that goals and objectives of the team are properly defined and clearly established Monitor effectiveness of collection efforts and maintains insurance billings are current within the established time frame specified in the department Training and development of the team members for optimum utilization and increased efficiency to meet business requirements. Compile and prepare various status reports for management in order to analyze trends and make recommendations I am a presentable person with good communication (linguist) , administration & insurance co-ordination . Medical and Clinical Operation Auditing, clinical documentation Improvement Denial analyst and management Pricing and matrix preparation according to DHA and DOH guidelines Coding expert and trained in ICD 9 and 10 , CPT4 , E & M and DGR codes ( member in AAPC and DOH for coding ) LEAD in Jawda and Tasneef policies procedures ,contacts, communications and Achieved 96 % quality in IP,ER ,DAYCARE AND OP 98 % /dental claims and coding Communicating to Insurance companies and TPAs as per the requirement of clients (hospitals and medical centers. At the Corporate level of 4 multi specialty hospitals, 11 medical centers , pharmacies With the patient care and complains handling. Clients from the DAMAN, ADNIC, NAS , ALICO NEXTCARE & other Insurance. Handling from the patients insurance card , approval for the OP/IP request from the insurance company Inclusions and exclusion of the diagnosis, procedures according to the company wise .And also experience from the payer side ( Alico Insurance company ) Medical auditing of the OP and IP claims before submission of the claims .And also the resubmission of the claims – Daman , NAS ,Adnic & other insurances ; in compliance with this achieved excellent result of payment Denial analysis and management plan –training physicians , front office staff and all involved in RCM Clinical documentation improvement and feedback training to all concerned –nurses and physicians Maintaining rejection rate less than 3.5 %. Experience in handling team of 3 to 50 staff – comprising of coders, billers , insurance co ordinators , claims processor , resubmission staffs, Auditors and claim processors – complete RCM . Professional & Academic Qualification

Accomplishments

  • Collaborated with team in the development of projects
  • Supervised team of 5 to 50 staff members.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Documented and resolved issues which led to positive results

Affiliations

  • Lions Club
  • Rotary International

Software

MS Office-Word,Excel,powerpoint,outlook, HIM softwares-concept

Interests

Light music

Flower and floral arrangement

Vegetable-carving

Indian classical and folk dance

Painting

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

The way to get started is to quit talking and begin doing.
Walt Disney

Timeline

Internal Audit and CDI Manager

UMED,Abudhabi/ kanad Hospital, AL Ain
06.2021 - Current

SIX SIGMA GREEN BELT -

SIX SIGMA GREEN BELT
03.2021 - 04.2021

Resubmission Team Assistant Manager

• VPS claims care –Burjeel hospital , Medoer , Lifecare Dubai, Abudhabi, sharjah and AlAIN
03.2021 - 05.2021

HoD , Senior Insurance and RCM Manager

Emirates International hospital group, Al Ain, UAE
07.2019 - 02.2021

RCM Manager

Avivo group of hospitals Abu Dhabi units
03.2018 - 09.2018

Insurance / Onsite Operation Manager (project lead)

ACCUMED RCM solutions Dubai
09.2016 - 01.2018

CPHQ Training in Professional Healthcare Quality Abu Dhabi - Healthcare Quality Management

Professional Healthcare Quality
08.2016 - 08.2016

Insurance Manager

Wellness One Day surgery Center
08.2014 - 08.2016

Training For CCA – Certified Coding Associate - Coding

Acorn Research ( Accredited By DHA,UAE)
07.2013 - 07.2013

Senior Medical Officer/Denial analyst

Al Noor Group of Hospitals(Mediclinic Middle east)
10.2011 - 06.2014

Certification in DRG & E & M Coding - Coding

Department of Health
08.2010 - 08.2010

Coordinator & In Charge ,Insurance Dep/Supervisor

Ahalia Hospital
01.2010 - 07.2011

Insurance coordinator

NMC Hospital
11.2008 - 08.2009

Insurance Consultant & Networking With Group Insur

American Life Insurance company
04.2006 - 05.2008

Insurance consultant

ALICO
04.2006 - 05.2008

ASST. DENTIST and Marketing manager

Ravari Dental Clinic
05.2005 - 04.2006

Assistant Dentist

German Dental Clinic
10.2004 - 11.2004

MS Word , MS Excel And Power Point Presentation - Microsoft Office

Dubai Cultural & Scientific Institute
11.2003 - 12.2003

Dental Assistant

Jebel Ali International Hospital
08.2002 - 04.2003

Dental Surgeon

VAN ALLEN HOSPITAL
06.2001 - 06.2002

No Degree - Advanced Excel Functions , Format Painting ,

Aims Training Center
04.2001 -

Dental Surgeon

CSI HOSPITAL
09.1998 - 05.2001

Dental Surgeon

Sara Dental clinic
09.1998 - 06.2001

Complusory Rotatory Clinical Internship - Dentistry

P.M.N.M .DENTAL COLLEGE
08.1997 - 08.1998

BDS - undefined

N.M.DENTAL COLLEGE& HOSPITAL KARNATAK UNIVERSITY
01.1993 - 01.1997

Professional Diploma - healthcare administration

University of Notting Hill

M.D Alternate - Medicine

Srilankan Open University
in telephonic -. communication skills
CPC coding trained IP/OP/ER ,ICD 10 CM completed training in TIME Training center Abu Dhabi 2017
Trained and certified by HAAD/DOH , Abu Dhabi in DRG and E&M coding 2010
Trained in MS-Office from Dubai Cultural & Scientific Institute, Dubai. (Approved by Ministry of Education, United Arab Emirates) yr 2003
Savitha RajakumarHOD /SENIOR MANAGER–PROVIDER RELATIONS /INSURANCE /BUSINESS STRATERGY