Dineesha George

HCC Risk adjustment Coding

• Adhered strictly to all HIPAA regulations when handling confidential patient information
• Analyzed provider documentation to ensure accurate coding of diagnoses and procedures according to CMS Medicare Risk Adjustment Coding Guidelines.
• Ensuring that all diagnoses are captured and documented accurately
• Assigning the appropriate ICD 10 CM codes to reflect the patient's overall health status
• Collaborating with other healthcare professionals to ensure the proper documentation of patient care
• Staying up-to-date with coding guidelines and regulatory changes
• consistently maintain a minimum 95% accuracy on coding quality audits
• Meet minimum productivity requirements a outlined by the project terms
• Handle other duties as required or assigned
• Entered patient insurance, demographic and health information into software and confirmed records.
• Maintained positive working relationship with fellow staff and management
• Participated in team meetings with other coders and supervisors
• Maintained current knowledge of changes related to ICD-10, CPT and HCPCS codes, modifiers,CMS regulations.

HEDIS abstraction
Control of Blood pressure

• Conducted comprehensive HEDIS abstraction for Control of Blood Pressure measures, ensuring accurate and timely data extraction.
• Demonstrated expertise in reviewing patient records to identify instances of blood pressure measurement and control.

BP Control in Diabetes Patients

• HEDIS abstraction focused on Blood Pressure control specifically in diabetes patients.
• Analyzed electronic health records to identify diabetic patients and assess their blood pressure control status.

Claims auditing - Dubai provider

• collecting, compiling and performing audits of medical charts, billing and other documentation.
• Maintaining medical charts records and performing regular reviews
• Developed and maintained standard auditing policies and procedures.
• Queried provider regarding missing, unclear, or conflicting health record documentation using approved templates.
• Educate providers about correct documentation and coding with provided educational materials.

Fraud and Abuse Detection in Claims Auditing

• Conducted thorough audits of insurance claims, specializing in identifying instances of fraud and abuse.
• Detected and reported cases of medical incompetencies, ensuring compliance with industry standards and ethical practices.

Quality Measure Development

• Metric logic creation.
• Code set development using relevant HAAD codes.
• Measure testing.
• Output validation.

Denials Management

• Manages denials by identifying trends and patterns in denied claims.
• Follow-Up on denials by correcting the root cause of denials will serve in reducing the volume of payer
  denials and rejections,resulting in accurate reimbursement from payers.
• Identified and addressed instances of unbundling of bundled procedures, preventing fraudulent billing practices and improving cost efficiency.
• Analyzed Evaluation and Management (E&M coding errors, implementing corrective measures to enhance accuracy and adherence to coding guidelines.
• Utilized advanced analytical skills to uncover discrepancies and irregularities in medical documentation, preventing potential financial losses.

Clinical documentation Improvement

• Providing consultation for improving documentation in specific specialties that impact reimbursement
• Adherence to standards of documentation will protect the organization during claim audits.

Population Health Dashboard

• Health development for statistics and trend analysis

• CPC CERTIFIED
• AAPC member ID -01545478
• NAME - DINEESHA KG