John Francis A. Velasco CPC, CCS

Experience

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  MiraMed: A Global Services Company

  Jul 2013 - Jul 2016

  Medical Coder I

  • Abreast in utilizing HCPCS level III, ICD-9, and CPT for the coding. Assigns andsequences ICD-9-CM/CPT/HCPCS codes to diagnoses and procedures for documentinformation that most accurately describes each documented diagnosis, surgicalprocedure, and special therapy or procedure according to established guidelines.• Familiar with different client tools such as ED Pace, EPIC Hyperspace, 3M encoder,Cerner Millennium, and other Citrix HIM applications and software.• Ensure corrected input of patient demographic, insurance, and physicianinformation. Ensure that all codes are entered in accordance with company policiesand procedures. Make sure that any discrepancies are addressed immediately.• Collect health information as documented by medical specialists and code themappropriately. Ensure that codes tally with doctors’ diagnoses. Consult medicalspecialists for further clarification and understanding of items on patient charts toavoid any misinterpretations.• Responded to client queries if needed and help them process some claims forproper reimbursement.• Extracting relevant information from patient records and ensuring compliance withmedical coding policies and guidelines.• Audits clinical documentation and coded data to validate documentation supportsservices rendered for reimbursement and reporting purposes. Additionally,assigning codes for reimbursements, research, and compliance with regulatoryrequirements utilizing guidelines. Show less

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  Omega Healthcare Management Services Private Limited

  Aug 2016 - Jan 2018

  Home Health Medical Coder

  • Reviews OASIS, Plan of Care, and communicates errors with clinical staff timely.Responsible for reviewing and providing feedback for appropriate and accurateCoding/OASIS documentation submitted by home health clinicians, ensuringadherence to federal standards, guidelines, and coding conventions. Able to codeand review a minimum of fifteen OASIS daily.• Communicates with Clinical Management regarding trends in errors or insufficientdata. Provide recommendations to the Clinical Services Manager (CSM) for potentialedits to the OASIS documentation within the approved timeframe, as designated bythe agency.• Review all electronically submitted documentation to ensure the records reflectcompliance with medical necessity, support initial visit data, describe individualpatient assessments, and support selected coding.• Participate in at least monthly clinical group training focused on Coding/OASISopportunities, as identified by submitted assessments. Show less

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  Sheikh Shakhbout Medical City - SSMC

  Feb 2018 - Apr 2018

  Clinical Coder

  • Reviewing and assigning appropriate E/M, diagnosis, and procedure codes based onthe clinician’s documentation available in medical records, for pre-authorizationpurposes and to ensure proper reimbursement for the facility.• Querying physicians when code assignments are not straightforward ordocumentation in the record is inadequate, ambiguous, and unclear for codingpurposes.• Validating information on all medical claims from patients seeking payment fromtheir insurance company. Claims were thoroughly reviewed to ensure that there isno missing or incomplete information. Keeping meticulous records of claims andfollowing up on lapsed cases. Determines covered medical insurance losses bystudying provisions of policy or certificate.• Complying consistently with facility policies, procedures, and practices and ensuringalignment with SEHA facility policies and with any regulations related. Show less

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  Czech Rehabilitation Hospital

  May 2018 - May 2020

  Medical Coder RCM (Submission & Resubmission)

  • Receiving data for reconciliation/resubmission from the account department oreclaim system and analyzing rejections, sort out as per denial code/reason andprocessing.• Gathering the pertinent information that is needful and sorting out the rejection asper denial reason.• Submitting the claims with proper reasons/justification for the codes and format toinsurance companies.• Ensuring to follow all the updated HAAD adjudication policies and procedureguidelines.• Making sure that the final rejection is at its minimal level and should meet theresubmission productivity targets within the stipulated time for all insurancecompanies.• Always maintaining strict confidentiality related to medical records and other data.• Ensures that we are very knowledgeable in updates about the insurance proceduresand policies. Show less

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  Mediclinic Middle East

  May 2020 - Jun 2021

  Insurance Administrator / Medical Coder

  • Reading and analyzing patient records, ensuring codes are accurate and sequencedcorrectly. Review claims data to ensure that assigned codes meet required legal andinsurance rules and that required signatures and authorizations are in place prior tosubmission while maintaining patient confidentiality and information security.• Assist with medical necessity documentation to expedite approvals and ensure thatappropriate follow-up is performed.• Collaborate with other departments to assist in obtaining pre-authorizations in across-functional manner.• Providing orientation and coding education to coders, pre-authorization co-coordinators,denial prevention specialists, physicians, and nurses regarding documentation and queryeffectively to ensure better documentation.• Works closely with Senior Financial Counselors to contact patients whose approvalrequests are denied and not deemed medically necessary by the third-party payer.• Complies with departmental quality standards and productivity measures.• Effectively communicates with patients, insurance payers, physicians, and otherstakeholders as necessary.• Possesses detailed knowledge of insurance providers, their portals, and theirexpectations for authorization approvals.Accurately interprets medical records in order to obtain appropriate associateddiagnoses, procedures, and additional service codes to support the medical necessityof services being rendered.• Resolves work queues within acceptable timeframes to ensure medical servicesprovided to patients are not delayed.• Knowledgeable of ICD-10 and CPT codes, HCPCS Codes, CDT, DOH Adjudication Rules. Show less

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  Yas Clinic

  Jul 2021 - Dec 2023

  Medical Coder / Authorization Officer

  • Acts as a resource when necessary for billing, pre-authorization and reimbursementissues, and coding. Ability to accurately interpret different insurance cards to defineeligible services including but not limited to network eligibility, patient share, andpreauthorization requirement.• Prepares and processes all referral and preauthorization requirements necessary forinsurance approvals.• Contacts internal clinical team and/or external clinics or healthcare facilities to obtainpertinent information needed to accurately complete referral/pre-authorizationrequests.• Review accuracy and completeness of the information requested and ensure that allsupporting documents are present. Receive requests for pre-authorizations andensure that they are properly and closely monitored.• Collaborate with the billing department to ensure all bills are satisfied in a timelymanner. Communicate with insurance companies about coding errors and disputes.• Follows up with patients when applicable to provide updates on authorization status.• Utilizes third-party payer/insurance authorization portals when appropriate.• Monitors referral Work queues in the Electronic Medical Record (EMR) throughoutthe day to capture referral requests in real-time.• Reviews and interprets pertinent medical record information for patient history,diagnosis, and previous treatment plans and decides on the information that is mostappropriate to provide for authorization requirements.• Ability to Interpret different tables of benefits (SOB) and exclusions for differentinsurance plans.• Follows all established Lean workflows to meet the highest level of efficiency andtimeliness for patients.• Aware of current trends related to medical necessity, denials, DRG and HAAD Claims,and Adjudication Rules and coding guidelines. Show less

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  Abu Dhabi Civil Defence Authority

  Jan 2024 - now

  Ambulance Coding Specialist

  • Auditing records to ensure proper submission of services prior to billing on pre-determined selected charges.• Providing correct HCPCS code and CPT code on all procedures and services performed. • Attending seminars and in-services as required to be updated on coding issues.• Auditing medical records to ensure proper coding completed and to ensure compliance with HAAD Regulation and Rules.• Following coding guidelines and legal requirements to ensure compliance HAAD regulation and rules.• Code the most accuracy level of diagnosis like external cause, place of occurrence and activity code.• Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.• Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria. Show less