SHAHALA PARVEEN.K CPC

• Processed pre-approval requests based on medical necessity, ensuring compliance with UAE insurance policies.
• Accurately applied CPT and ICD-10 CM codes in accordance with established guidelines.
• Submitted approvals for OPD and emergency services using Riayati and DHPO systems.
• Communicated with insurance companies to facilitate prompt approval of medical services.
• Provided guidance to patients about coverage limitations, exclusions, and co-payments.
• Kept detailed electronic records to assist with audits and reimbursements.
• Maintained compliance with patient confidentiality standards and data privacy regulations in UAE.
• Responded to inquiries from treating physicians regarding insurance approval criteria and service coverage.

• Tracked and updated approval statuses through Riayati Unified Portal for effective submission management.

• Executed coding tasks for pre-authorization, claims submission, and re-submissions with precision.

• Reduced denials by verifying claim accuracy and enhancing turnaround times.

• Facilitated patient payment processing and account reconciliation to meet revenue cycle management objectives.

• Ensured compliance with insurance regulations and medical documentation standards.

• Collaborated with healthcare providers to resolve billing discrepancies and optimize reimbursement rates.

• Managed patient insurance verification processes to guarantee accurate claims submissions.

• Verified insurance eligibility and coverage for patients ahead of appointments, ensuring accuracy.

• Acquired pre-authorization for required medical procedures to streamline processes.

• Processed co-payments and issued receipts in accordance with clinic finance guidelines.

• Registered patients efficiently in Electronic Medical Records (EMR) systems for optimal data management.

• Supported insurance claim submission and follow-up efforts to decrease rejection rates.

• Managed front desk operations, providing effective patient check-in and scheduling services.

• Facilitated improved service delivery through coordination between patients and medical staff.