SHARAFUDHEEN MUHAMMED

• Oversee the full revenue cycle process including pre-authorization, eligibility verification, coding, billing, and collections.
• Ensure accurate and timely claims submissionLead and manage a team of billing and collection officers, coders, and insurance coordinators.
• Monitor and analyze claim rejection trends and manage timely re-submissions and appeals.
• Ensure strict adherence to DHA, HAAD, and MOH regulations and compliance standards.
• Collaborate with clinical and finance teams to optimize revenue capture and audit readiness.
• Provide monthly KPI reports on collections, aging, denial rates, and revenue performance.
• Implement and maintain RCM software such as Insta,clinic Pro,SAP,CRS,Hospicare,unite

• Reconciliation of Invoices accordingly to amount received.
• Identifying of Medical and Billing rejection as per Denial codes.
• Updating of Denial code as per insurance company and justifying the rejection reason for billing.
• Communicate effectively with insurance providers, internal departments, and other stakeholders to resolve reconciliation issues.
• Investigate and resolve discrepancies in billing and coding.
• Coordinate with relevant departments to address any billing errors or missing information.
• Denial Management
• Ensure compliance with regulatory requirements and industry standards related to insurance financial transactions.
• Prepare and submit reports on reconciliation activities, discrepancies, and resolution outcomes.
• Allocating claims according to TAT
• Conduct regular reconciliations of insurance accounts to ensure accuracy and completeness of financial records.
• Identify and investigate discrepancies between billed and received amounts.
• Collaborate with insurance providers to resolve any outstanding issues or discrepancie

• Downloading of remittance from E-Claim Link (DHPO) software and by mails.
• Reconciliation of Invoices accordingly to amount received.
• Identifying of Medical and Billing rejection as per Denial codes.
  Updating of Denial code as per insurance company and justifying the rejection reason for billing.
• Separation of medical rejection Invoice and submitting to Doctor for justification.
• Evaluation of Price list and discount list applied in invoices.
• Verification of Card number, Copay Collect and Sub –Company in particular invoices.
• Resubmission of reconciled Invoices and forwarding back to insurance company for reprocess and it settlement.
• Recommends system improvements and follow-up with IT department for the implementation of modification and improvements
• Communication with insurance company for any of issues and concerns. Discussion with team member and seniors for any matters, new processing idea, Data updating, etc.
• Generating monthly report of pending Invoices and amount to be reconciled and resubmitted.
• Maintaining of payment rejection value and ageing reports of Invoices.
• Preparation of outstanding reports of Invoice Settlement of all companies to management
• Should meet the resubmission productivity targets within the

stipulated time for all insurance companies.

• Ensure accurate application of contractual prices and discounts, schedule of benefits, correct allocation of benefits, collection of deductibles, co-payments, observance of policy limits, and adherence to claims submission protocols.
• Committee member of resolving issues and developing system

· Resubmission of reconciled Invoices and forwarding back to insurance company for reprocess and it settlement.

· Recommends system improvements and follow-up with IT department for the implementation of modification and improvements

· Communication with insurance company for any of issues and concerns.

· Discussion with team member and seniors for any matters, new processing idea, Data updating, etc.

· Generating monthly report of pending Invoices and amount to be reconciled and resubmitted.

· Maintaining of payment rejection value and ageing reports of Invoices.

· Preparation of outstanding reports of Invoice Settlement of all companies to management

· Should meet the resubmission productivity targets within the stipulated time for all insurance companies.

· Ensure accurate application of contractual prices and discounts, schedule of benefits, correct allocation of benefits, collection of deductibles, co-payments, observance of policy limits, and adherence to claims submission protocols.

· Committee member of resolving issues and developing system

• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Researches and analyzes data needs for reimbursement.
• Analyzes medical records and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff.
• Reviews and verifies documentation supports diagnoses, procedures and treatment results. Identifies diagnostic and procedural information.
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines. Follows coding conventions.
• Serves as coding consultant to care providers.
• Identifies discrepancies, potential quality of care, and billing issues. Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
• Identifies reportable elements, complications, and other procedures.
• Serves as resource and subject matter expert to other coding staff. Assists lead or supervisor in orienting, training, and mentoring staff.
• Provides ongoing training to staff as needed.
• Handles special projects as requested.
• specialties Handling : General Medicine |Internal Medicine |Filmy Medicine | Pediatrics |Orthopedics |Neurology | Urology | Ophthalmology |Obstetrics and genecology | Dermatology |Cardiology | Radiology | Gastroenterology| ENT |Physiotherapy

• Assigned codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes
• Ensured codes are accurate and sequenced correctly in accordance with government and insurance regulations
• Collated with the provider on any documentation that is insufficient or unclear
• Adeptly cross-checking the claims: checking all the claims like eligibility, co-payment details, services entered correct or not, correct
• ICD and CPT are entered,
• and all the services are billed Handled dental claims by doing approvals and submissions, as well as accepting operative approvals with proper diagnosis and CPT
• Organized appropriate training sessions for the front desk, billing department, doctors' offices, laboratories, and radiology departments
• Specialties: Claim Rejection Handling | Deficiency Identification | Claim Information Confidentiality | Team Management