Vimal Savalia
Rutherford,NJ
Summary
Medical Coding and Reimbursement Specialist with 10+ years of expertise in CPT, HCPCS, ICD-10, CMS guidelines, coding compliance, auditing, denial management, and revenue cycle optimization. Proven ability to maximize reimbursement, ensure regulatory compliance, and collaborate effectively with providers and payers.
Overview
1
1
Language
1
1
Certification
15
15
years of professional experience
Work History
Medical Policy / Coding Integration Analyst
Horizon Blue Cross Blue Shield of New Jersey
Newark, USA
11.2014 - Current
- Reviewed 100 medical policies annually, maintained coverage-criteria files by adding, revising, and retiring CPT/HCPCS/ICD codes prior to implementation, ensuring accurate claim adjudication and reimbursement.
- Interpret and codify prior authorization, utilization management, and medical necessity criteria into coverage policies and code logic that govern claim adjudication, aligning determinations with clinical guidelines and regulatory mandates.
- Monitored compliance with clinical and coding policies across reviewed data, ensured alignment between coverage policy and coding logic.
- Completed 50 ad hoc reviews annually, resolved internal and external inquiries into current and historical code changes - effective dates, edit messaging, and coverage/parameter limitations - while advising cross-functional stakeholders.
Medical Coder
Allegiance Billing & Consulting
Bloomfield, USA
07.2013 - 11.2014
- Performed emergency department facility and evaluation & management (E/M) coding and abstracted operative reports for general, pulmonary, and cardiovascular surgeries, assigning ICD-9-CM and CPT codes to enhance billing accuracy.
- Applied correct modifiers and coding guidelines to secure maximum appropriate reimbursement.
- Conducted prospective coding audits within department to ensure coding accuracy and compliance with regulatory standards.
Medical Biller & Coder
Golden Medical Billing
Hawthorne, USA
09.2011 - 01.2013
- Coded and submitted a high volume of electronic medical claims; posted insurance and patient payments and tracked denials, copays, and balances.
- Corrected denied claims and prepared appeals, ensuring timely follow-up with payers for accurate reimbursement.
- Liaised with physicians, patients, and insurance representatives to resolve account disputes and secure necessary documentation.
Education
Medical Coding & Anatomy Program -
US Career Institute
01-2012
Bachelor of Commerce - Accounting & Auditing
Jaihind College
Mumbai, India01-1997
Skills
- CPT coding compliance
- Policy writing
- Medical terminology
- CPT coding compliance compliance
- Data analysis
- Claim processing analysis
Certification
- CPC, COC (CPC-H), CPMA Certifications
Languages
Hindi
Native/ Bilingual
Timeline
Medical Policy / Coding Integration Analyst
Horizon Blue Cross Blue Shield of New Jersey
11.2014 - Current
Medical Coder
Allegiance Billing & Consulting
07.2013 - 11.2014
Medical Biller & Coder
Golden Medical Billing
09.2011 - 01.2013
Medical Coding & Anatomy Program -
US Career Institute
Bachelor of Commerce - Accounting & Auditing
Jaihind College