Dr.Kiruba Michael
Chennai
Summary
Healthcare professional with 9+ years of experience in healthcare RCM, claims adjudication and compliance. Proven ability to perform root cause analysis, resolve claim issues, and drive process improvements to support a seamless revenue cycle.
Overview
10
10
years of professional experience
2
2
Certifications
Work History
Senior Medical Coder
Paix Services
05.2024 - Current
- Assigned ICD-10 and CPT codes with accuracy, ensuring compliance with payer/ government regulations.
- Conducted root cause analysis of denials and documentation gaps, collaborating with vendors and internal teams.
- Reviewed patient charts for accuracy; delivered audit-ready outputs.
- Generated daily operational reports, highlighting spikes/ dips in coding volumes.
Senior Associate
APM Medical Billers
08.2022 - 05.2024
- Reviewed medical records for accurate coding and standardized documentation.
- Conducted pre-authorization reviews, reducing approval delays and denials.
- Liaised between providers, operations, and audit teams to clarify clinical data.
Medical Officer
National Life & General Insurance
01.2019 - 03.2022
- Performed medical necessity reviews of inpatient, outpatient, and maternity claims.
- Ensured compliance with policy coverage, SOPs, and regulatory guidelines.
Medical Officer
Speak Medicare
04.2018 - 11.2018
- Reviewed high-risk claims to identify fraud, abuse, and utilization anomalies.
- Prepared analytical and clinical summaries supporting investigation outcomes.
Deputy Manager
Star Health & Allied Insurance
11.2015 - 04.2018
- Performed medical necessity reviews of inpatient, outpatient, and maternity claims.
- Ensured compliance with policy coverage, SOPs, and regulatory guidelines.
Education
MBA - Health Service Management
Anna University
Tamilnadu01.2018
BDS - Bachelor of Dental Surgery
Ragas Dental College And Hospital
Tamilnadu01.2015
Skills
- ICD‑10‑CM, CPT
- Power BI (PL‑300 Certified),
- Healthcare RCM Operations & Compliance
- Root Cause Analysis & Claims Resolution
- EMR/EHR Workflow Optimization
- Analytical Reporting & Trend Identification
- Stakeholder Communication & Client Interaction
- Process Improvement & Documentation Accuracy
Certification
Certified Professional Coder (AAPC – CPC, 97%)
Projects
- ICD‑10 2026 Coding Dashboard (Power BI): Built a dashboard to analyze ICD‑10 code updates, enabling coders to quickly identify added, revised, and deleted codes for improved accuracy and compliance.
Timeline
Senior Medical Coder
Paix Services
05.2024 - Current
Senior Associate
APM Medical Billers
08.2022 - 05.2024
Medical Officer
National Life & General Insurance
01.2019 - 03.2022
Medical Officer
Speak Medicare
04.2018 - 11.2018
Deputy Manager
Star Health & Allied Insurance
11.2015 - 04.2018
MBA - Health Service Management
Anna University
BDS - Bachelor of Dental Surgery
Ragas Dental College And Hospital