Dr.Kiruba Michael
Chennai
Summary
With a solid background in the health insurance sector, I am eager to expand my knowledge and pursue a dynamic career that fosters continuous learning, innovation, and skill development.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Senior Medical Coder
PAIX SERVICES
05.2024 - Current
- Adept at coding for a wide range of U.S. healthcare services, including inpatient, outpatient, and specialty procedures, using ICD-10-CM, CPT, and HCPCS systems in compliance with CMS and payer requirements.
- Understanding in U.S. healthcare revenue cycle management and compliance with NCCI edits, leading to improved reimbursement and reduced claim rejections.
- Proficient in utilizing EMR/EHR systems to access patient records and ensure accurate coding within the U.S. healthcare framework.
Senior Associate
APM MEDICAL BILLERS
08.2022 - 05.2024
- Accurately assign ICD-10, CPT, and HCPCS codes to diagnoses and procedures in compliance with coding guidelines and collaborated with healthcare providers, insurance companies, and patients to obtain necessary documentation.
- Analyze medical data in EMR, treatment plans, and associated costs to determine appropriateness for pre-authorization.
- Successfully completed a deputation assignment at the onsite location of Saudi German Hospital in the UAE, contributing to the improvement of the pre-approval process for medical procedures and treatments through active collaboration.
Medical Officer
NATIONAL LIFE AND GENERAL INSURANCE CORPORATION LIMITED SUPPORTING SERVICES
01.2019 - 03.2022
- Processed Emergency claims, Inpatient (IP) claims, Outpatient (OP) claims, Dental, Optical, Maternity, Alternative treatment and Group Mediclaim's in Reimbursement and Cashless basis
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records and entered data into application software
- Calculated deductibles, co-payments, and refunds
- Trained new hires in all aspects of job
Medical Officer
SPEAK MEDICARE
04.2018 - 11.2018
- Analyzed medical treatment records, police reports, and information gathered by investigation
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Used Microsoft Word to create documents
- Generated information detailing findings and provided reporting for forecast analysis and reporting in support of decision-making while claim processing
Deputy Manager
STAR HEALTH AND ALLIED INSURANCE CO. LIMITED.
11.2015 - 04.2018
- Handled Emergency, Inpatient (IP) and group Mediclaim claims through Reimbursement and Cashless process
- Adjudicated medical claims based on established processing criteria, either approving or denying them
- Investigated potential fraudulent claims, making decisions based on gathered information, investigation, and police reports
- Provided training and mentorship to new personnel recruited for the role
Education
MBA - Health Service Management
Anna University
08.2018
Bachelor of Dental Surgery -
Ragas Dental College And Hospital
10.2015
Skills
- US Healthcare
- Certified Medical Coder
- Electronic Medical Records (EMR) navigation
- Revenue cycle management
- Microsoft Office
- Inpatient and outpatient coding expertise
- Time Management
- Teamwork and collaboration
Certification
- CPC-A (AAPC), 97%
- Conversation course from the British Council
- Licentiate from Insurance Institute of India (III)
Timeline
Senior Medical Coder
PAIX SERVICES
05.2024 - Current
Senior Associate
APM MEDICAL BILLERS
08.2022 - 05.2024
Medical Officer
NATIONAL LIFE AND GENERAL INSURANCE CORPORATION LIMITED SUPPORTING SERVICES
01.2019 - 03.2022
Medical Officer
SPEAK MEDICARE
04.2018 - 11.2018
Deputy Manager
STAR HEALTH AND ALLIED INSURANCE CO. LIMITED.
11.2015 - 04.2018
MBA - Health Service Management
Anna University
Bachelor of Dental Surgery -
Ragas Dental College And Hospital
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