Dayana Rony Antony
Doha
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously. Disciplined individual skilled in collecting and verifying patient demographic and insurance information and preparing and maintaining medical records. Proficient in using medical terminology and classifying diagnostic procedures, treatments and medications. Dedicated to providing highest quality care to patients.
Overview
10
10
years of professional experience
Work History
Medical Insurance Coordinator- Pharmacy
Al Emadi Hospital
01.2023 - Current
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and ICD 10 Coding.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Maintained accuracy, completeness, and security for medical records and health information.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Responded to correspondence from insurance companies.
- Reviewed provider coding information to report services and verify correctness.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Processed insurance payments and maintained accurate documentation of payments.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Followed up on denied claims to verify timely patient payment and resolution.
- Generated reports on medical claims processing activities and results.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Identified and resolved discrepancies between patient information and claims data.
- Processed and tracked requests for medical records from external organizations.
- Tracked and monitored requests for medical records release.
- Verified accuracy of patient information in medical records.
- Scanned and uploaded medical records into electronic medical records system.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
Pharmacy Assistant /Data Entry Clerk
Ibn Al Haytham Pharmacy
10.2019 - 12.2022
- Counted and labeled prescriptions with correct item and quantity.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Communicated instructions to patients or caregivers about proper use and storage of drugs.
- Kept pharmacy counter and related areas clean, neat and organized.
- Trained new pharmacy staff on computer system and drug management protocols.
- Completed and filed documentation for insurance, store and liability purposes.
- Assisted pharmacy staff with preparing medications and filling orders.
- Updated computer system with current customer, payment and inventory information.
- Greeted customers and responded to questions with friendly, knowledgeable assistance.
- Verified order information against computer database.
- Answered telephones and provided information about order status, store hours and pharmacy procedures.
- Received incoming supplies and stocked in correct locations.
- Supported operations with filing, copying and faxing.
- Merchandised over-the-counter goods and rotated stock.
- Completed cash register transactions by handling credit and cash payments using pharmacy register system.
- Re-stocked shelves with prescribed medications and health care products.
- Verified patient information to correctly dispense medications.
- Greeted customers at counter and provided excellent customer service.
- Located and measured medications according to prescription information, making modifications as instructed by pharmacists and providers.
- Answered questions regarding medication instructions and usage.
- Coordinated with insurance representatives to process claims and calculate correct co-pay information for patients.
- Monitored inventory levels to inform pharmacists of shortages and facilitate resupply.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Supported pharmacists with day-to-day activities and pharmacy office management functions.
- Handled inventory stock by counting inventory items, checking delivery quantities, reviewing medication expirations and ordering additional products.
- Processed payments for prescriptions and accurately completed cash and credit card transactions.
- Assisted customers in selecting over-the-counter medications and health care products.
- Organized pharmacy area to maintain clean and orderly environment.
- Located and processed ready prescriptions to customers, distributed medication information documentation and facilitated medication consultations.
- Prepared packaging and labels for prescriptions, verifying accuracy of dosage, side effects, interactions, and refill instructions.
- Generated labels for prescriptions and maintained accurate records.
- Maintained records of prescriptions filled for patients by completing pharmacy log and updating customer accounts.
- Established and maintained patient profiles, updating organizational database with current information.
- Organized, sorted, and checked input data against original documents.
- Collated and organized data entry documents into filing systems for easy access.
- Communicated with supervisors and colleagues to process data quickly and resolve discrepancies.
- Developed data entry policies and procedures in compliance with company standards.
- Secured and protected data from unauthorized access by complying with security protocols.
Insurance Coordinator
Royal Sheild Insurance Brokerage
12.2018 - 06.2019
- Prepared insurance claims for submission to clearinghouses or insurance companies.
- Filed and tracked insurance claims and communicated claims status to patients.
- Verified insurance and communicated coverage to staff and patients.
- Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Referenced monthly aging reports to follow up on unpaid claims and obtain maximum reimbursement.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
Diabetes Educator
Medical Trust Hospital
03.2014 - 09.2015
- Participated in medication administration and documentation.
- Maintained and completed documentation.
- Maintained general cleanliness and safety of facility and resident rooms.
- Assisted and responded to call lights, phone and in-person requests for information.
- Assisted nutritional staff with serving meals and enhancing mealtime experience.
- Designed and conducted health education surveys to assess health needs and risk factors within communities.
- Identified and applied for grants and acquired alternate funding as needed to support health education programs.
- Created pamphlets, videos and other health education materials to promote health awareness and preventive health practices.
- Educated and trained healthcare providers on health education practices for patients.
- Analyzed health data and created reports to present to community leaders and stakeholders.
- Conducted health screenings and assessments to identify health needs and risk factors for individuals and communities.
- Continually improved knowledge, skills, and performance based on feedback and self-identified professional developmental needs.
- Provided technical assistance to healthcare providers and organizations to improve health education services.
- Developed and implemented health education programs to help individuals and communities improve health and well-being.
- Participated in health education research initiatives, developing and evaluating health education programs.
- Collaborated with other healthcare professionals to design and deliver health education services to clients.
- Established and maintained partnerships with community organizations to promote health education programs.
- Implemented health promotion campaigns to raise awareness of health-related issues.
- Assisted with development of improved seminars and training materials.
- Promoted available resources and connected individuals with services.
- Recommended health education curricula for healthcare providers, community organizations and schools.
- Monitored health trends and data to identify health concerns and develop related health education initiatives.
- Taught health education classes for community workers and members of public.
- Gave public talks on importance of health education and specific disease prevention and treatment strategies.
Education
Master of Science - Diabetes Science
06.2013
Skills
- Team Management
- Organizational Skills
- Computer Skills
- Relationship Building
- Organization and Time Management
- Attention to Detail
- MS Office
- Written Communication
- Dependable and Responsible
- Multitasking Abilities
- Flexible and Adaptable
Timeline
Medical Insurance Coordinator- Pharmacy - Al Emadi Hospital
01.2023 - Current
Pharmacy Assistant /Data Entry Clerk - Ibn Al Haytham Pharmacy
10.2019 - 12.2022
Insurance Coordinator - Royal Sheild Insurance Brokerage
12.2018 - 06.2019
Diabetes Educator - Medical Trust Hospital
03.2014 - 09.2015
Amrita Institute of Medical Sciences - Master of Science, Diabetes Science