Urja Shah, CPC
Ahmedabad
Summary
Dynamic healthcare professional with a proven track record at Ace Healthcare Solutions, excelling in clinical quality and coding management. Skilled in team leadership and operational efficiency, I implemented coding policies that enhanced accuracy and compliance. Adept in data analysis and client relationship management, I fostered collaboration to streamline claims processing and improve team performance.
Overview
6
6
years of professional experience
Work History
Manager- Clinical Quality and Coding
Ace Healthcare Solutions
Ahmendabad
10.2024 - Current
- Lead a team of 12 coding professionals, ensuring accurate and timely coding for medical records, diagnoses, and procedures.
- Develop and implement coding policies and procedures to maintain accuracy, compliance with regulatory standards (ICD-10, CPT, HCPCS), and improve operational efficiency.
- Perform audits to identify errors and discrepancies, providing coaching and training to team members to enhance coding accuracy.
- Collaborate with physicians, healthcare providers, and insurance companies to resolve coding issues and ensure smooth claims processing.
- Conduct regular team meetings to discuss performance, address challenges, and ensure a high level of motivation and team alignment with company objectives.
- Ensure compliance with HIPAA regulations and other healthcare standards to protect patient confidentiality and data integrity.
Medical Coder
Ace healthcare solutions
09.2022 - 09.2024
- Reviewing and verifying documentation supports diagnoses, procedures and treatment results
- Identifying diagnostic and procedural information
- Generation of codes for hospital consultation and subsequent visits
- Coding and abstracting patient encounters, including diagnostic and procedural information, significant reportable elements, and complications
- Claim creation and Scrubbing
- Worked on Account receivable and Denial management
Mentor and Medical Coder
Meditab Software pvt ltd.
07.2019 - 07.2022
- Resourcefully used various coding books, procedure manuals and on-line encoders
- Planned, developed and implemented strategies to convey information to team of 10 members
- Reached out to insurance carriers to obtain prior authorization for testing and procedures
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals
- Tracked referral submission during facilitation of prior authorization issuance
- Reviewed patient records, identified medical codes and created invoices for billing purposes
- Trained new employees on multiple medical billing programs and data entry software
Education
M.Pharma - Pharmaceutics
Saraswati institute of pharmaceutical sciences
01.2021
B.Pharma - Pharmacy
Saraswati Institute of pharmaceutical sciences
01.2019
Skills
- Data Research & Analysis
- Team Building & Leadership
- Client Relationship Management
- Clinical And Administrative
- Standard Operating Procedures (SOPs)
- MS Office Word
- MS Office Excel
- MS Office PowerPoint
Courses Certifications
Certified Professional Coder, from AAPC
Personal Information
Total Experience: 5 Years 0 Month
Timeline
Manager- Clinical Quality and Coding
Ace Healthcare Solutions
10.2024 - Current
Medical Coder
Ace healthcare solutions
09.2022 - 09.2024
Mentor and Medical Coder
Meditab Software pvt ltd.
07.2019 - 07.2022
M.Pharma - Pharmaceutics
Saraswati institute of pharmaceutical sciences
B.Pharma - Pharmacy
Saraswati Institute of pharmaceutical sciences
Similar Profiles
Somasundari DilipkumarSomasundari Dilipkumar
Account Representative at AUGMENT TECHNOLOGY SOLUTIONSAccount Representative at AUGMENT TECHNOLOGY SOLUTIONS
Malkeet KaurMalkeet Kaur
Health Care Assistant at Ace Healthcare limited solutionsHealth Care Assistant at Ace Healthcare limited solutions
Aceca Johnson ScottAceca Johnson Scott
Administrative Assistant at Ace Healthcare Training InstitiuteAdministrative Assistant at Ace Healthcare Training Institiute