Kanwal Zehra
Physician , Coding and RCM Manager
Jeddah
Summary
Highly skilled Medical Rectification Manager with over 5 years of experience in the healthcare sector, specializing in the analysis and rectification of medical reports and data. Solid background in team leadership and a proven track record in streamlining coding processes and achieving high standards in coding accuracy and compliance. Instrumental in re-adjudicating rejection claims in a denial management department. Consistently improving report accuracy, enhancing data integrity, and streamlining reporting processes. Adept at implementing corrective measures and ensuring compliance with regulatory standards. Proven ability to work collaboratively with cross-functional teams, contributing to achieving operational excellence and supporting high-quality patient care.
Overview
17
17
years of professional experience
7
7
years of post-secondary education
3
3
Languages
Work History
Medical Rectification Manager (Denial Management)
Dr. Soliman Fakeeh Hospital
08.2023 - Current
- Analysis of Medical Rejections
- Review Rejections: Systematically review and analyze medical claims that have been rejected by insurance companies and other payers
- Identify Patterns: Look for trends or common reasons behind the rejections, such as missing information, coding errors, or discrepancies in patient data
- Rejection Reporting
- Generate Reports: Create detailed reports on medical claim rejections, including the frequency, causes, and financial impact of these rejections
- Highlight Key Data: Focus on identifying the top ten departments and top ten doctors with the highest number of rejections
- Report Submission: Prepare and send these reports to the CEO on a monthly basis, ensuring they are clear, concise, and actionable
- Departmental and Doctor Performance Review
- Analyze Performance: Evaluate performance metrics for different departments and individual doctors based on rejection rates
- Top Ten Lists: Maintain and update lists of the top ten departments and doctors with the highest rejection rates, providing insights into areas needing improvement
- One-on-One Sessions
- Schedule Sessions: Arrange and conduct individual sessions with doctors to discuss their specific rejected cases
- Provide Guidance: Offer advice on how to address common issues leading to rejections and strategies for improving claim acceptance rates
- Dedicational Support: Educate doctors on best practices for documentation, coding, and submitting claims to minimize rejections
- Collaborate with Insurance Companies and Payers
- Understand Rejection Reasons: Work closely with insurance companies and other payers to understand the reasons for claim rejections
- Solutions: Collaborate with them to develop and implement solutions that reduce the likelihood of future rejections
- Continuous Improvement
- Review Processes: Regularly assess and refine internal processes for claim submissions and management to improve efficiency and reduce errors
- Implement Training: Develop and provide training materials or workshops for staff on proper claim documentation and submission techniques
- Review Denied Claims: Examine the details of rejected claims to understand the reasons for denial
- This includes looking at coding errors, missing information, or other issues that led to the claim being denied
- Correct Errors: Make necessary corrections to claims based on the identified issues
- This might involve updating coding, providing additional documentation, or correcting patient information
- Resubmit Claims: After making corrections, resubmit the claims to the appropriate payer
- Ensure that the revised claim meets all requirements to avoid further denials
Supervisor Medical Coding
Dr. Soliman Hospital
08.2022 - 08.2023
- Overseeing medical document and helping department resolve their revenue cycle problems
- Ensure compliance with coding and clinical documentation relevant healthcare regulation
- Prepare and reviews performance metrics with the Revenue Cycle Director
- Managing wide range of activities pertaining to the review and coding of Inpatients and Out patients
- Establishes implement and maintain a formalized review process for coding compliance, including a formal review audit process, designs and uses audit tool to monitor the accuracy of clinical coding
- Performs data quality review on inpatient records to validate the international classification of disease Manual (ICD 10 AM) and other codes; verifies Diagnoses Related Group (DRG) GROUP
- Create and monitor inpatient case mix report and the top DRGS in the facility to identify patterns trends and variation in the facility's frequently assigned DR group investigate and evaluate potential causes for changes or problems
- Continuously Evaluate the quality of clinical documentation to identify incomplete or inconsistent document for inpatient and /or outpatient encounter that impact the code selection and resulting APC/DRG group and payment
- Maintain knowledge of current and required coding certificates and appropriate selects assign, and train subordinate technical and clerical staff, direct monitor and evaluate work
- Monitor unbilled account reports for outstanding services or un coded discharge to reduce accounts receivable days for inpatients and outpatients
Medical Claims Processor & Reviewer
Mednet Saudi Arabia LLC
03.2020 - 08.2021
- Managed large volume of medical claims on daily basis exceeding daily average set target
- Responded to correspondence from insurance companies and providers
- Reviewed provider coding information to report services and verify correctness
- Maintained confidentiality of patient finances, records and health statuses
- Reviewed outstanding requests and redirected workloads to complete projects on time
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Process all daily batches of claims assigned applying best medical knowledge in conjunction with company policy and CCHI policies
- Over saw daily claim operations to ensure high levels of productivity as acting supervisor
- Identified issues analyzed information and provide solution to problems
- Reviews patient medical records for all relevant diseases and assigns corresponding lCD codes according to standard coding guidelines
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
General Physician
New Sidra Medical Center
07.2017 - 08.2019
- Assessing patients' condition rapidly with accuracy, resuscitate and stabilize the patient if needed
- Applying safe and reliable methods for immediate management of injured patients
- Note keeping of the complaints, history, clinical findings, investigations
- Determined appropriate treatments to achieve balance in body
General Physician
Karachi Children and General Hospital
06.2013 - 01.2015
- Teamed with other physicians, specialists and health care providers to provide well-rounded care for complex cases
- Monitored patients recovering post-operatively from major and minor procedures
- Treated and monitored care of geriatric patients at local long-term care facility
- Implemented therapeutic regiments involving medications and other interventions to mitigate symptoms and prevent reoccurrence
- Diagnosed and treated patients suffering from chronic conditions
- Identified serious conditions and emergency situations and immediately referred to hospital for prompt care
- Conferred with specialists to obtain expertise on patient conditions and referred individuals in need of additional care
- Assessing patients' condition rapidly with accuracy, resuscitate and stabilize the patient if needed
- Applying safe and reliable methods for immediate management of injured patients
- Note keeping of the complaints, history, clinical findings, investigations
General Physician
Al Abeer Medical Center
06.2012 - 04.2013
- Assessing patients' condition rapidly with accuracy, resuscitate and stabilize the patient if needed
- Applying safe and reliable methods for immediate management of injured patients
- Consultation including examination, investigation and treatment or referral to concerned specialty if needed
- Note keeping of the complaints, history, clinical findings, investigations and treatment given to the patients over paper and computer
- Providing optimum care to the patient
- Primary health care management for staff and their families
RMO
Karachi Children and General Hospital
04.2009 - 06.2012
- Teamed with other physicians, specialists and health care providers to provide well-rounded care for complex cases
- Monitored patients recovering post-operatively from major and minor procedures
- Treated and monitored care of geriatric patients at local long-term care facility
- Implemented therapeutic regiments involving medications and other interventions to mitigate symptoms and prevent reoccurrence
- Diagnosed and treated patients suffering from chronic conditions
- Identified serious conditions and emergency situations and immediately referred to hospital for prompt care
- Conferred with specialists to obtain expertise on patient conditions and referred individuals in need of additional care
- Assessing patients' condition rapidly with accuracy, resuscitate and stabilize the patient if needed
- Applying safe and reliable methods for immediate management of injured patients
- Note keeping of the complaints, history, clinical findings, investigations
House Officer
Abbasi Shaheed Hospital
12.2007 - 12.2008
- Detailed History taking and note keeping of patients
- Assisting the consultants and residents in their clinical rounds
- Assisting the seniors during medical and surgical procedures
- Assisting the surgeons during emergency and day surgeries
- Assisting in the management of outpatient as well as in patients of the wards
- Responsible to carry out all the management lines of the patients of the allotted beds as advised by consultants
- Assisting in the resuscitation, stabilizing and advance care of the critical cases
Education
MBBS - Medicine
Sir Syed College of Medical Sciences
01.2000 - 05.2006
Medical Coding - Professional Certification
EHealth Education Australia & Selat For Business
01.2022 - 09.2022
Revenue Cycle Management - Professional development completed in Revenue Cycle Management
Selat For Business Solutions
Advance Excel, MIS Report and Data Analysis - undefined
Techcraft
Skills
Claims Management
Timeline
Medical Rectification Manager (Denial Management)
Dr. Soliman Fakeeh Hospital
08.2023 - Current
Supervisor Medical Coding
Dr. Soliman Hospital
08.2022 - 08.2023
Medical Coding - Professional Certification
EHealth Education Australia & Selat For Business
01.2022 - 09.2022
Medical Claims Processor & Reviewer
Mednet Saudi Arabia LLC
03.2020 - 08.2021
General Physician
New Sidra Medical Center
07.2017 - 08.2019
General Physician
Karachi Children and General Hospital
06.2013 - 01.2015
General Physician
Al Abeer Medical Center
06.2012 - 04.2013
RMO
Karachi Children and General Hospital
04.2009 - 06.2012
House Officer
Abbasi Shaheed Hospital
12.2007 - 12.2008
MBBS - Medicine
Sir Syed College of Medical Sciences
01.2000 - 05.2006
Advance Excel, MIS Report and Data Analysis - undefined
Techcraft
Revenue Cycle Management - Professional development completed in Revenue Cycle Management
Selat For Business Solutions
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