Chandana

Professional Summary:

·      Senior claims officer with 13 years’ experience (7 years in India and 6 years in UAE)

·      Knowledge of DOH guidelines

·      Creating self-pay packages for all specialties

·      Getting contracts for Unlisted procedures from DOH

·      Good knowledge in RCM billing and adjudication rules.

Achievements:

·      Received “Ovations Award” for my Quality performance in Cognizant Technology Solutions (CTS) in the year 2010

Professional Experience

Hospital:        SHEIKH KHALIFA MEDICAL CITY, Abu Dhabi

Duration:       April 2017 to till date.

Position:         Senior Billing Analyst

Software :      Salamtak – Revenue cycle

Responsibilities as a Senior Billing Analyst:

·      Validate & submit the claims to payer by utilizing back end auto scrubbers to avoid denials.

·      Escalate to respective departments for any clarifications and follow up with the team to ensure clean claim submission.

·      Creating self-pay packages for different specialties.

·      Identifying the Unlisted procedures and request the physician to provide necessary documents and share it to SEHA to get contract.

·      Identify and analyze the codes that are dropping without price and prepare the workflow to increase Revenue.

·      Extracting Hold/Pending charge Reports, Patient share reconciliation and assigning tasks to team for submissions and make sure all self-pay encounters to submitted within 72 hours.

·      Extract Encounters that are not being discharge from the Hold report and share to clinic to update discharge date & time. Eg: Emergency/Day Surgery/Observation type.

·      Identifying and escalating issues with concerned team for the Observation/Day surgery encounters that are discharged more than 1 night stay to confirm Encounter type or to modify discharge date/time.

·      Ensure to submit late charges as per the current policies.

·      Provide prompt responses on ADHOC requests from the physicians or other Payers.

·      Review on claims and ensure clean claim submission within the accepted timeline. Created & review on internal scrubber on submission of claims to reduce percentage of denials.

·      Preventing denials of CLAI 08 by daily monitoring and merging of encounters.

·      Update internal scrubber on timely manner as per DOH updates to avoid denials.

·      Escalate authorization issues to Patient Financial Counsellors to revise the authorizations as per the rendered services to avoid denials.

·      Update the team with all polices of Insurance and DOH.

·      Maintain productivity and monitor work performance of team.

·      Validate and report testing results to SEHA on system enhancements.

·      Maintain back up on Adjudication rules and updates.

·      Develop efficiencies to reduce manual intervention.

·      Continue to engage in taking additional responsibilities besides daily tasks.