BHUVANESH KUMAR KALAIMANI

• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Focused on outpatient facility coding ( e.g., ambulatory surgery,ER,observation)
• Performed professional and facility coding for specialty e.g multi-specialty clinc acute care hospital
• Accurately assigned CPT code(96360,96361) and ICD code for ED hydration and infusion services (96365,96367,96374,96375)etc.
• Trained new coders on infusion therapy coding guidelines.

• Experience in outpatient ED and E&M and HCC coding and resubmissions
• Secured batch topper in the coding training section
• Secured my quality above 97%
• Awarded star coder in Nthrive healthcare
• Done auditing for the fresher and experienced coders

• Selected for the cross-training opportunity in surgery coding at Ajuba.
• This is an incredible change to expand my skills,deepen my understanding of surgical procedure, and contribute even more effectively to our team.
• Surgical CPT Coding (e.g., 10021-69990)
• Modifier Usage(e.g., 22,XU,XS,78)
• Medical terminology (Surgical specialities)
• EM coding for pre &post op visits.

Worked Offsite from Chennai in SEHA (Abu Dhabi) from August 2021 to
January 2023
Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates Clinical Coder
(Outsourced –Global healthcare)
Working in Emergency Department as Clinical Coder by assigning CPT code sets
including 99281-99285 for ED, 99201-99205 (New Patient) and 99211-99215
(Established Patent) for Office/Outpatient visits, and 99241-99245 for Office
Consultations along with supporting Diagnosis codes and necessary ED
procedure codes like infusions, nebulizations, bedside ultrasound/echo, splints,
lacerations, burn cares, incision and drainages, etc. Communicating with other
departments like nursing team, pharmacy team, and billing team to clear the
hurdles in submitting a claim. Auditing team members’ work by taking random
samples to give feedback on monthly basis for quality work and also participating
in annual HAAD audits. Preparing monthly work schedule for the team to provide
the coder coverage in the emergency department 24x7 and 365 days.
Interaction with physicians for lack of documentation and medical necessity for
the services provided to the patients to minimize the denial percentage from the
payers. Generate and submit daily production reports and ED level tracking
reports to Coding Manager. Conducting CDI (Clinical Documentation
Improvement) sessions to physicians/residents on individual basis once or twice
in a year as required.

• Experience in *payment integrity, claims auditing, and surgical coding compliance. Proficient in **CPT, ICD-10, HCPCS, and DRG validation* to ensure accurate reimbursement and prevent fraud, waste, and abuse (FWA). Skilled in *auditing surgical claims, identifying billing discrepancies, and improving revenue cycle efficiency."
• Conducted *pre-payment and post-payment audits* for surgical claims to ensure coding accuracy and compliance.
• Identified *overpayments, underpayments, and incorrect coding* (e.g., unbundling, upcoding, modifier misuse).
• Developed *QA audit reports* with findings and recommendations to improve coding accuracy

• I gained extensive knowledge in the IPDRG coding. After excellent training in
  medical coding here Inpatient Coding (IP-Physician Coding) on how to assign.
• - Accurately assigned ICD-10-CM, CPT, and HCPCS codes for *surgical procedures* (e.g., general surgery, orthopedics, cardiology, etc.).
  - Reviewed *operative reports* to ensure proper documentation and coding compliance
• Ensured compliance with *NCCI edits* and payer-specific policies.
• Assisted in training new coders on *surgical coding best

practices

• Conducted internal audits, improving coding accuracy to *98%