Kunjan Dalal
Senior Clinical Coding Analyst
Summary
Dependable Senior Coding Analyst with proven knowledge of electronic health records software, complex document oversight, and medical terminology. Excellent work ethic and exemplary time management skills, demonstrated over nine years of expertise in healthcare and pharmaceutical industry. Diligent mentor driven to resolve issues and conflicts effectively while remaining calm in all types of situations. Looking to take on a challenging role with an established organization.
Overview
9
9
years of professional experience
15
15
years of post-secondary education
Work History
Senior Clinical Analyst
Cotiviti
Pune
11.2019 - Current
- Analyzing, preparing and supporting appeals by writing narratives and grievances in compliance with state, federal and other regulatory requirements
- Researching, investigating and summarizing complex issues using state and federal mandate benefits and supported appeals review for denied inpatient, acute and outpatient services
- Monitored acceptance rates for assigned clients and assist management in proactively detecting negative deviations
- Performed daily audits on client data for completeness and accuracy of coding utilizing both ICD-10 CM guidelines and medical records.
- Worked with US based appeals and grievance staff to coordinate documentation, decisions and notifications of outcome for various patients
- Contributed to PCI reports by providing feedback and reviewing claims with medical records and preparing appeal narrative for overpayment and underpayment by incorporating ICD-10 CM, HCPCS and policies of various health care facilities
- Adhered to official coding guidelines, coding clinic determinations using client specific guidelines, CMS and regulatory compliance guidelines by utilizing multiple internal and external computer applications and programs.
- Collected, reviewed and analyzed data from diverse departments for appropriate reimbursement.
- Maintained excellent attendance record, consistently arriving to work on time and recently recognized as the performer of the year award at Cotiviti.
- Improved operations through consistent hard work and dedication.
- Participated in team-building activities to enhance working relationships.
Senior Clinical Coder
Queensland Health
Brisbane
03.2018 - 05.2019
- Demonstrated ability to assign accurate codes with highest specificity using ICD-10 AM, ACHI guidelines and DRG grouping according to Australian Coding standards and state clinical coding authority guidelines, Queensland health admitted data collection policy and legislative guidelines with designated timeframes.
- Identified discrepancies between clinical information systems and patient medical records, and obtained feedback through appropriate channel.
- Reviewed the accuracy of DRGs allocated to admitted patient episodes prior to finalizing coded data with associated information such as length of stay and care type.
- Actively participated in quality improvement activities by providing coding expertise to trainee coders, new hires, and acquired skills to code complex cases during monthly coding deadline at rehabilitation and palliative care centers within Queensland Health.
- Influenced the quality of documentation and clinical coding through liaison with clinicians by utilization of Queensland health documentation query process.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Implemented new coding procedures that reduced mistakes and simplified processes.
- Initiated, performed and documented quarterly coding audits for hospital acquired conditions.
Clinical Coder
Queensland Health
Brisbane
11.2016 - 03.2018
- Assignment of diagnostic and procedural coding for tertiary casemix by reviewing the inpatient information using EMR, pathology reports, laboratory reports, by visiting rehabilitation and palliative centres for additional missing medical information.
- Liaison with physicians and other healthcare providers to obtain or clarify clinical information.
- Coding of wide range of specialties as Medicine, Neurology, Surgery, ED, Oncology, Gastroenterology, Vascular, Ophthalmic , Rehabilitation, Palliative care categories.
- Performed regular coding quality audits including targeted ABF, DRG, ACHS data validation, documentation or ad hoc audits.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
Medical Records Administrator
PA hospital
Brisbane
04.2014 - 08.2016
- Handled high-volume data entry of demographics, disease etiology and extent and associated procedures or treatments.
- Ability to identify and maintain quality management strategies in relation to medical records services and chart management.
- Oversaw secure transfer of patient records to other health care providers to support requests and authorizations.
- Maintained accuracy, completeness and security for medical records and health information.
- Utilized OSIM, 3M, HBCIS and patient registration modules to manage and confirm patient data, such as insurance, demographic and medical history information.
- Reviewed open and closed records to comply with medical record documentation policies and reported findings to Health service manager.
- Evaluated requests for information and maintained and tracked releases to comply with federal and state laws.
- Created and maintained safeguards against unauthorized access and use of computer-based medical records.
- Communicated effectively with staff, patients and insurance companies by email and telephone.
Drug Safety Associate
TATA CONSULTANCY SERVICES, Mumbai for ROCHE
Mumbai
09.2011 - 06.2013
- Liaison with internal and external personnel on all levels regarding clinical trials and regulatory submissions.
- Assisted in recording, tracking of receipts, submissions and distribution of adverse events and reports from regulatory authorities.
- Interacted with reporting manager to discuss ongoing projects and maintain workflow and timelines.
- Processed collected data in company databases as per applicable standards, legislation, regulations and guidelines.
- Compared adverse event source documents against safety database screens for transcription and medical accuracy.
- Understanding of ICH GCP and drug development process.
- Worked with Safety Physicians as needed for medical monitoring activities such as reviewing and follow up of patient eligibility criteria for inclusion/exclusion in clinical trial and reviewed study specific model ICFs according ICH-GCP criteria.
Education
Certified Professional Coder from AAPC - Membership ID 01791030 - MEDICAL CODER
AAPC
USA 06.2020 - 08.2020
MBA - Masters of Business
Holmes Institute
Australia 07.2016 - Current
PG diploma - CLINICAL RESEARCH And PHARMACOVIGILANCE
CLINIMINDS
Mumbai 11.2010 - 12.2011
Pre-University - Science, Biology
MUHS university, WILLINGDON College
08.2004 - 08.2010
Certification in Produced Clinical Coded Data
TAFE NSW
Australia 07.2016 - 03.2018
Skills
Problem-Solving
undefinedAccomplishments
- Consistently recognized and awarded as top performer for 100% quality and 100% productivity at current organization.
- Trained and successfully lead a team of 5 staff members in the past organization. Additionally was a part of the team of 5, to receive Excellence service and contribution awards from Queensland government in Australia, Brisbane.
- Achieved 88% in CPC, 84% for TAFE NSW, Australia and MBA distinction (transcripts available on request).
Timeline
Certified Professional Coder from AAPC - Membership ID 01791030 - MEDICAL CODER
AAPC
06.2020 - 08.2020
Senior Clinical Analyst
Cotiviti
11.2019 - Current
Senior Clinical Coder
Queensland Health
03.2018 - 05.2019
Clinical Coder
Queensland Health
11.2016 - 03.2018
MBA - Masters of Business
Holmes Institute
07.2016 - Current
Certification in Produced Clinical Coded Data
TAFE NSW
07.2016 - 03.2018
Medical Records Administrator
PA hospital
04.2014 - 08.2016
Drug Safety Associate
TATA CONSULTANCY SERVICES, Mumbai for ROCHE
09.2011 - 06.2013
PG diploma - CLINICAL RESEARCH And PHARMACOVIGILANCE
CLINIMINDS
11.2010 - 12.2011
Pre-University - Science, Biology
MUHS university, WILLINGDON College
08.2004 - 08.2010
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