Shayan Sultan Khan
Abu Dhabi
Summary
Diligent and accomplished Revenue Cycle Management (RCM) professional with over 5 years of dedicated experience within the UAE healthcare industry. Expertise spans both provider and payer domains, coupled with an in-depth understanding of intricate medical terminology, procedures, billing intricacies, and regulatory protocols. Proven adeptness in insurance coordination, data extraction, charge,capture and analysis, coupled with proficiency in charge-capture validation, claims processing, medical billing, submissions, and denial management. My career objective is to harness my comprehensive knowledge of coding guidelines and robust analytical capabilities to drive organizational growth and excellence. Committed to optimizing revenue cycles and ensuring seamless financial operations within healthcare settings.
Overview
5
5
years of professional experience
Work History
Data Management Officer / Internal Medical Auditor
National Health Insurance Company - Daman
09.2022 - Current
- Extracting provider data on multiple type of facilities such as out-patient, in-patient, dental, Homecare, Pharmacy and Long-term care facilities using Microsoft SQL server management system
- Conducting simple and complex analysis using excel and SQL on the various type facilities highlighting patterns and irregularities
- Participated in audit planning and organizing of audit activities with the onsite auditors by providing data driven scenarios to have a more focused approach while conducting audits
- Conducting regular sample reviews on the audits samples to ensure accurateness prior to finalization of an audit
- Collaborated with internal and external stake holder for cost containment identifier outlier providers and abusive behavior
- Coordinated with auditors to evaluate the strategies and scenarios put in place to analyze a provider and update them on regular intervals
- Investigate complaints raised by people against providers and evaluating them and raising those complaints to appropriate audit teams for further investigation
- Defined and documented the logic used to extract the scenario so the auditor understands the logic e.g., codes that cannot be billed simultaneously
- Highlighted and focused on previous abusive behavior of the provider and validated it with data and did a comparative analysis to ensure if the provider is still behaving in the same manner
- Communicated with provider about disagreed claims as part of Internal Medical Audit (IMA) team and tried to resolve the disputed claims
- Prepared recovery sheets and sent them to finance to ensure that payments are recovered in a timely manner.
Medical Coder & Insurance Coordinator
Amrita medical Center
09.2020 - 07.2022
- Detailed Working knowledge of CPT, ICD 10 CM commonly used in an outpatient setting for various specialties such as internal medicine, Orthopedics, Urology, Ob/Gyn, Physiotherapy, Radiological services, and Dental services
- Analyzing medical records against billed procedures to ensure accuracy of diagnostic and Evaluation and Management codes
- Extensive working knowledge on EMR & the techniques and guidelines of medical coding
- Assessing patient’s medical charts and identified discrepancies in the medical documentation afterward communicating such discrepancies to the management and medical staff to reduce such error
- Conducting routine audits on patient’s medical records to ensure documentation quality and coding accuracy
- Identifying internal and external factors that lead to non-payment of claims
- Working in a fast-paced medical office with multiple specialties while maintaining quality work standards
- Maintained minimal denial rate of 5%
- Routinely communicating with insurance providers regarding submitted invoices, reasons of rejections, doctor empanelment, Facility, and doctor license updates etc
- Designed a detailed training program on office procedures to ensure high quality patient care and constantly modifying as per insurance guidelines it to ensure quality outcomes
- Mentoring new staff in different aspects such as insurance policies, pre-approval procedures, and documentation requirements to safeguard against future rejections or take backs
- Facilitating in reduction of nonpayment percentage from 11% to 5% per company
- Collaborated with medical staff to optimize authorization procedure to minimize first response denials from insurance companies
- Facilitated and represented the facility as a team member during “JAWDA - Tasneef” audits in 2020 and 2021.
Insurance Coordinator
P2P Medical Practice Management
01.2020 - 08.2020
- Verify patients’ eligibility, covered services and dental insurance coverage monetary limit to calculate deductibles, co-insurance and out of pocket costs and provide the “Patient’s share
- Promptly provided support to patients, physicians, billing departments and coordinate with Insurance/TPA regarding eligibility, claims and appeals
- Obtained approvals for medical procedures requiring “Pre-authorization” for a variety of specialties such as Ob/Gyne, Orthopedics, Dental, and Physiotherapy
- Collaborated and educated the staff in matters such as Pre-Authorization and mandatory documentation to ensure positive response in the first attempt
- Developed documentation “Check-List” for different specialties to reduce the Turnaround Time for approvals
- Well versed in approval protocols for various insurance companies and insurance plans such as Daman, Nas, Neuron, AXA, NextCare, Inayah, Iris etc
- Developed a system to ensure all approvals are logged and saved for future reference
- Developed Practices to ensure all approval protocols are followed.
Insurance Coordinator & Billing Officer
Exelcius Practice Management
01.2019 - 12.2019
- Running Patients eligibility checks through the designated insurance portals: Pulse, Open jet, Jet, Neuron, AXA, DHPO etc
- Assigned patients to the designated doctor
- Scheduled appointment over the phone and for walk-in patients
- Reviewing and adjudicating medical claims in accordance with regulator’s claim processing guidelines
- Working off the daily work queue while maintaining quality standards
- Experience in a production-based environment with an emphasis on quality outcomes
- Responsible to work on new claims daily and interface with other departments to obtain necessary information required for resolution of claims
- Calculated patients’ coverage and accordingly applied for dental approvals as per the documentation of the doctor
- Ensured correct charge capture for the rendered services
- Developed an error list to help reduce the price denials
- Worked in under pressure and delivered quality outcomes.
Education
Bachelor of Business -
Swinburne University of Technology
2016
Skills
- Healthcare fraud abuse and Waste Analysis
- Healthcare Billing Trend Analysis
- End-End RCM Management
- IP-OP Coding (CPT, DRG, HCPCS)
Medical Auditor & Medical Coder
- Medical Terminology
- Data Abstraction
- 3M Encoder
- Patient Data Compilation
- SQL Script Writing
Accomplishments
· Certified Professional Medical Auditor - AAPC, USA
· Certified Professional Coder - AAPC, USA
· Lean Six Sigma Yellow Belt Certified - Anexxa Institute, UAE
· Introduction To Human Anatomy - Charles Strut University, Australia
· SQL for Data Science - UC Davis,USA
· Health Data Analytics - St. Scholastica College, USA
· Health System Strengthening - University of Melbourne, Australia
· Big Data Analytics - Griffith University, Australia
· Principles Of Project Management - St. Scholastica College, USA
· A Look at Operational Implications from Covid-19 - Harvard University, USA
· English For Healthcare - King’s Collage London, U.K
· Healthy Futures - Murdock University, Australia
· Introduction To Business Management - King’s College London, U.K
· Clinical Care Severe Acute Respiratory Infection, World Health Organization
· Emerging Respiratory Viruses & Covid-19 Disease, World Health Organization
Languages
English
Bilingual or Proficient (C2)
Urdu
Bilingual or Proficient (C2)
Hindi
Bilingual or Proficient (C2)
Punjabi
Bilingual or Proficient (C2)
Timeline
Data Management Officer / Internal Medical Auditor
National Health Insurance Company - Daman
09.2022 - Current
Medical Coder & Insurance Coordinator
Amrita medical Center
09.2020 - 07.2022
Insurance Coordinator
P2P Medical Practice Management
01.2020 - 08.2020
Insurance Coordinator & Billing Officer
Exelcius Practice Management
01.2019 - 12.2019
Bachelor of Business -
Swinburne University of Technology
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