SUMITRA LIMBU
Al Ain, ,UAE
Summary
A highly skilled professional CPC Clinical Coder with extensive expertise in health insurance billing rules and local guidelines, specialising in outpatient E/M, ER, and radiology coding. Demonstrates strong teamwork and collaboration abilities, coupled with proficiency in Microsoft Office. Experienced in auditing and managing pre-authorisation processes for inpatient, outpatient, and day care services as per insurance policies. Adept at coordinating with physicians, insurances, and patients to ensure seamless operations. Committed to leveraging skills in a dynamic healthcare environment to enhance operational efficiency.
Overview
4
4
years of professional experience
4
4
years of post-secondary education
1
1
Certification
Work history
Insurance Coordinator – Pre-Authorization & Claims
Ain Al Khaleej Hospital
Al ain, UAE
2024.11 - Current
- Verified patient insurance eligibility and coverage through insurance portals
- Submitted pre-authorization requests for procedures, investigations, and treatments.
- Uploaded required medical documents including prescriptions, reports, and clinical notes.
- Applied correct ICD and CPT codes for diagnosis and procedures during submission.
- Coordinated with doctors and internal departments for additional medical information when required.
- Followed up on approval status with insurance companies such as Daman Health Insurance and Sukoon Insurance.
- Communicated with insurance companies and physicians to resolve denied claims and provide additional medical justification when required.
- Maintained records of submitted requests, approvals, denials, and authorization reference numbers.
- Assisted patients by explaining insurance coverage, co-payment, and approval outcomes.
Health Assistant
Dhankuta District Hospital
Koshi, Nepal
2022.03 - 2024.05
- Responsible for documenting and keeping track of patient information such as medical history, vital signs, and test results.
- Assist patients with personal hygiene, take vital signs, and monitor patients for changes in condition.
- Assist with procedures such as blood sampling, medication administration, and wound care.
- Schedule appointments, arrange transportation, and communicate with other healthcare experts to help organize patient care.
- To visit hospitals and medical clinics by taking the patients as per their medical emergencies.
- Educate patients on issues like as drug management, disease prevention, and good lifestyle choices.
- In responsible for maintaining and restocking medical equipment and supplies as needed.
- Communicate with healthcare experts including doctors and nurses to report changes in patient conditions, provide updates on patient care, and receive patient management advice.
- Monitor patients' condition, provide assistance as needed, and report any concerns to healthcare experts to ensure that they are safe and comfortable during their care. Must follow healthcare legislation and standards relating to patient care, privacy, and safety.
Education
License - General Medicine
Dhankuta Institute of Health Science
2018.01 - 2022.01
Skills
- Sound Knowledge of Health Insurance billing rules and local health insurance Guidelines
- Teamwork/Collaboration
- Outpatient E/M, ER
- Radiology Coding
- Auditing
- Microsoft Office
- Submission & Resubmission Pre-Auth-IP, OP, DAYCARE as per insurance policy Calls
- ManagementPhysicians, Insurances, Patients (working knowledge as preauth coordinator
Certification
- AAPC, CPC
- CPC CLINICAL CODER
- (BLS) American Heart Association / 2024
Languages
English
Hindi
Nepalese
PERSONAL DETAILS
- Date of Birth : JAN 12, 2001
- Sex : Female
- Marital Status : Unmarried
- Nationality : Nepalese
Timeline
Insurance Coordinator – Pre-Authorization & Claims
Ain Al Khaleej Hospital
2024.11 - Current
Health Assistant
Dhankuta District Hospital
2022.03 - 2024.05
License - General Medicine
Dhankuta Institute of Health Science
2018.01 - 2022.01