Sujitha Mary Sankar
Dubai
Summary
Dedicated and detail-oriented Certified Medical Coder with over 8 years of experience in accurately coding outpatient medical records using ICD-10, CPT guidelines. Proven expertise in ensuring claim accuracy, reducing denials, and supporting efficient revenue cycle management. Skilled in analyzing medical documentation, Adept in using coding software and EHR systems including 3M, ICD 10 CM,INGENIX. Committed to continuous learning and upholding the highest standards in medical coding and healthcare data integrity.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Insurance Executive
Aster DM Healthcare
04.2024 - Current
- Reviewed and corrected denied or rejected claims to ensure accurate and timely resubmission to insurance carriers
- Analyzed rejection reports to identify patterns or coding issues, significantly reducing future claim denials
- Collaborated with billing, coding, and clinical teams to gather necessary documentation for resubmissions
- Maintained knowledge of insurance guidelines and payer-specific requirements to ensure compliance
- Monitored aging reports to prioritize high-value or time-sensitive resubmissions
- Ensured all resubmissions (DHPO And Riyati) met internal quality standards and industry regulations
- Resolved claim denials by submitting appeals or corrected claims with appropriate documentation
- Achieved a 32% resubmission success rate, reducing accounts receivable backlog and improving revenue cycle efficiency
- Trained new staff on resubmission workflows, denial management, and payer protocols.
Medical Coder
American Academy of Cosmetic Surgery Hospital
10.2023 - 02.2024
- Coding, Submission, resubmission, IP approvals of health care claims in order to get payment
- Resubmission of denied claims within time period. Review rejections from payers and assign appropriate codes
- Denial analysis and feedback to concerned physicians for queries raised after rejection
- Analysis of denial reasons and timely escalation
- Evaluated pre-authorization requests for medical procedures, hospital admissions, and treatments based on policy guidelines and clinical criteria
- Verified member eligibility, policy coverage, and benefit limits to determine approval or denial of claims
- Communicated approval or denial decisions to providers, patients, and internal departments in a timely and professional manner
- Ensured accurate and consistent application of medical necessity criteria during approval processes
- Liaised with physicians, hospital administrators, and claims teams to resolve discrepancies and expedite authorizations
- Supported the appeals team by preparing summaries and rationale for denied claims when requested
- Upload claims to DHPO.
Insurance Executive
Zulekha Hospital
06.2023 - 10.2023
- Well proficient in assigning accurate ICD-10-CM, CPT, and Dubai service listed codes performed in the Outpatient setting
- Knowledge about NCCI Edits, MEU Edits
- Billing, and managed patient balances in alignment with insurance remittance advice
- Cross Checking eligibility, payer ID, benefits and copay limits
- Ensuring all investigation reports are attached and preauthorization codes are entered correctly
- Insurance exclusions and other policies and adjudications of all insurance companies/TPAs
- Responsible for claim billing and patient outstanding amount
- Submitted Claims Through DHPO and Riyati Portal.
Insurance Executive
Aster DM Healthcare
03.2022 - 05.2023
- Responsible for coding & submission using accurate ICD, CPT,DSL & other services which is relevant for the submission.
- Handling Dubai & NE region claims & following DHA & Riayati guidelines.
- Responsible for the insurance updates & guidelines, in processing claims.
- Maintaining productivity (220 claims per day), reliability,
responsibility, attendance, dependability, organization and
accuracy/thoroughness.
Senior Medical coder
Omega
06.2021 - 12.2021
- Reviewing medical records and EMR notes for assigning accurate ICD-10-CM codes for diagnoses
- Reviewing provider documentation to determine diagnosis, comorbidities and complication
- Ensure office practices are in compliance with HIPAA regulations
- Adhering to coding guidelines, and queried physicians for clarification if needed.
Junior Medical Coder
Episource India Private Limited
07.2018 - 05.2021
- Having Sound knowledge in Risk adjustment analysis and also in different Scopes of risk adjustment
- Delivering Coding files on TAT without Delay
- Maintaining 99% of accuracy and productive quality.
- Reviewing Electronic medical records and Pending claims for physician queries.
Education
MSc - Biotechnology
Sri Sankara Arts and science college
04.2017
BSc - Biotechnology
Sri Sankara Arts And Science College
04.2015
Skills
- ICD 10 CM
- CPT
- DSL
- Expertise in Anatomy and physiology
- Microsoft Excel
- Medical Terminologies
- Insurance risk analysis
- 3M Encoder
- Datarap
- Citrix
- Lifetrenz
- HMIS
- Insta HMS
- Yasasi
- Ingenix (Optum 360)
Certification
- CPC - Certified Professional Coder
- CRC - Certified Risk Adjustment Coder
(Member ID# 01755755)
Languages
English
Proficient
C2
Telugu
Advanced
C1
Malayalam
Upper Intermediate
B2
Hindi
Beginner
A1
Tamil
Bilingual or Proficient (C2)
Hobbies and Interests
- Gardening
- Outdoor Activities
- Listening Music
- Cooking
- Internet Surfing
PERSONAL SKILLS
- Communication
- Team work
- Adaptability
- Leadership
- Attention to detail
- Emotional Intelligence
Accomplishments
- Awarded as a Quality coder for maintaining 99% quality at Episource india private limited
- Awarded as a Emerging star for maintaining 95% quality and 100% of Production at Episource india private limited
- Awarded as a Positive Spark for Collaboration quality and Customer service at Omega Healthcare Management services
Timeline
Insurance Executive
Aster DM Healthcare
04.2024 - Current
Medical Coder
American Academy of Cosmetic Surgery Hospital
10.2023 - 02.2024
Insurance Executive
Zulekha Hospital
06.2023 - 10.2023
Insurance Executive
Aster DM Healthcare
03.2022 - 05.2023
Senior Medical coder
Omega
06.2021 - 12.2021
Junior Medical Coder
Episource India Private Limited
07.2018 - 05.2021
MSc - Biotechnology
Sri Sankara Arts and science college
BSc - Biotechnology
Sri Sankara Arts And Science College
Similar Profiles
RAJASEKAR B SRAJASEKAR B S
ASSISTANT MANAGER – BIOMEDICAL DEPARTMENT at ASTER CLINICAL LAB LLP (ASTER DM HEALTHCARE)ASSISTANT MANAGER – BIOMEDICAL DEPARTMENT at ASTER CLINICAL LAB LLP (ASTER DM HEALTHCARE)
Shiju K NShiju K N
PROCUREMENT EXECUTIVE at Aster DM Healthcare Limited (Aster Medcity Hospital)PROCUREMENT EXECUTIVE at Aster DM Healthcare Limited (Aster Medcity Hospital)
RAJESH RAMURAJESH RAMU
REGISTERED PHARMACIST at Zahrat Al Shefa Medical Center-Aster DM HealthcareREGISTERED PHARMACIST at Zahrat Al Shefa Medical Center-Aster DM Healthcare
KHAN ABUZARKHAN ABUZAR
Resubmission Claims Officer at Aster DM healthcareResubmission Claims Officer at Aster DM healthcare
SADIQ ABBASSADIQ ABBAS
Banking Advisor at Fintrek Marketing Management LLCBanking Advisor at Fintrek Marketing Management LLC