Md Abdul Rahim, CRC

Experience

• 

  Knack Global

  Dec 2014 - May 2015

  AR Specialist

  • Used coded data to produce and submit claims to insurance companies• Worked directly with the insurance company, healthcare provider, and patient to get a claim processed and paid.• Reviewed and appealed for unpaid and denied claims.• Verified patient’s insurance coverage.• Handled collections on unpaid accounts.

• 

  Sunknowledge Services Inc.

  May 2015 - Nov 2016

  Medical Billing Specialist

  • Worked directly with the insurance company and healthcare provider to get a claim processed and paid.• Maintained up-to-date billing system and follow up on, collect and allocate payments.• Performed account reconciliations and generate age analysis.• Contacted clients to obtain or request additional information necessary for payment reimbursement.• Research and resolved payment discrepancies and investigates insurance denials to identify action necessary.• Accurately and in a timely manner posted all AR related payments to include ERA, EFT and check payments.• Transferred accounts to appropriate secondary payers or patient responsibility.• Followed HIPAA policies and procedures per company guidelines and maintain confidentiality of patient and proprietary information. Show less

• 

  COZEVA - Applied Research Works, Inc

  Nov 2016 - now

  • Playing as an integral part of the coding team and responsible for efficient and effective management of day-to-day operations.• Working along with the developers using NLP technology to enhance used cases for the betterment of our product.• Continuously worked as a medical tester for the NLP technology and found out cases that need further improvement.•Handling a team of medical coders and making sure that the team achieves the required quality and productivity as per the client’s standards. • Providing guidance and mentoring to subordinates and other employees.• Review reports to identify specific issues, investigate and correct as per the coding guidelines, and implemented solutions.• Providing medical expertise to the developers to fine tune and develop new features Show less My responsibilities include:Hedis Abstraction:• Review and analyse all medical records of the patients and abstracted the data as per the required data elements.• Accurately and efficiently conducted a medical record review specific to the Health Care Effectiveness Data Information Set (HEDIS).• Working experience on various HEDIS performance measures.• Helping our clients in there Hedis data submission by accurately reviewing their patient's supplemental data.Risk Adjustment:• Review medical charts electronically.• Working experience on various computerized coding programs and electronic health records (EClinicalWorks, Epic, Cerner, Allscripts).• Abstract and code diagnosis and documentation information to the highest level of specificity.• Helping our Dev team in building medical dictionary by abstracting data in form of CPT, ICD-10, LOINC, RXNORM codes from medical charts, wherein NLP based programming is used.• Perform ongoing analysis of medical record charts for the appropriate coding compliance.• Follow the Official ICD-10 guidelines for Coding and Reporting along with the guidelines of CMS risk adjustment and HCC risk adjustment.• Review annual wellness visits (AWV) charts on daily basis and working along with the team to perform daily audits.In this period also achieved Certified Risk Adjustment Coder (CRC) credential from AAPC. Show less

  • Medical Coding Manager

    Nov 2020 - now

  • HealthCare Data Analyst

    Sept 2018 - Oct 2020

  • EHR Support Specialist

    Nov 2016 - Aug 2018