Ahmed M.
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Certified Medical Coder | Auditor| Biller| AR Specialist | RCM Manager

Ex -Education Officer for AAPC Local Chapter Pakistan Qualification: Pharm-D (Doctor of Pharmacy) CERTIFICATIONS ● CPC (Certified Professional Coder) ● CPMA (Certified Professional Medical Auditor) OFFERING SERVICES I can provide complete RCM services including but limited to. ● Appointment Scheduling ● Eligibility & Benefits Verification ● Medical Coding ● Demographic & Charge Entry ● Insurance claims submission ● Claim Rejection ● Payment & Posting ● Secondary Claims Submission ● Account Receivable or Denial Management ● Medical Appeals ● Refunds (Insurance and Patient) ● ICD-10, CPT mapping ● Medical Scribing ● Credentialing ● Emails, and calls handling ● Virtual Assistant ● Front Office Services PROFESSIONAL SUMMARY ● 10+ years of multispecialty experience in the field of medical billing & coding ● Credit of establishing coding department in multiple US based RCM companies ● Diversified experience of dealing in multiple specialties/settings including but limited to Urgent Cares, Emergency Rooms (Freestanding), Ambulatory Surgical Centres, Hospitals (Profee - Micro to Tertiary care) Laboratories (General + Pathology + Genetic Testing), Diagnostic Radiology, Skilled Nursing Facilities, Wound Care Centres and other solo practices. ● Highly energetic and goal-oriented professional with promising managerial, teaching and training skills. ● Self- motivated and skilled individual equipped with knowledge and experience of team developing, strong decision making, leading and controlling coding tasks of 150+ providers of different specialties. ● Certified Professional Coder and Certified Professional Medical Auditor from AAPC, with profound knowledge of ICD-10 CM, CPT, HCPCS and modifiers and utilizing them efficiently. ● Developed and managed a sole medical coding department at a US based healthcare billing and IT Company, being the very first of its kind and by far the biggest coding facility of the country. ● Experience of efficient management of backlogs and claims denial. SUCCESFUL PROJECTS AND ACHEIVEMENTS ● NCD and LCD based cross walk to validate claim for medical necessity. ● Successfully developed and implemented NCCI based RBS rules and Modifier cross walk for appropriation of claims to be submitted. ● Conducted Coding audit campaign efficiently, based on 2012 OIG work plan. ● Introduced prescription verification for Sure script certification. ● Coordinated with Web EHR, MTBC soft and android development team, in ICD-9 to ICD-10 mapping module resulting in best android app of the time. ● Actively involved in process automation and verification of MTBC EHR (client end) MTBC soft (operations). ● Efficaciously revamped MTBC EHR according to the requirements of Meaningful Use (MU1, MU2 and MU3) Certification. ● Effectively managed incorporation of updates and changes in medical coding annually or when required. CORE COMPETENCIES AS MEDICAL BILLER, CODER & AUDITOR ● Extensive knowledge of medical terminology human anatomy and physiology, diagnostics, and pharmacology across a broad range of medical practice areas. ● Experience of dealing in multiple specialties including anesthesia, radiology, pathology, internal medicine and surgery. ● Certified proficient and experienced in ICD-10 requirements and procedures ● Comprehensive knowledge and utilization of CPT and HCPCS coding ● Working knowledge of compliance regulations HIPAA and PHI requirements. ● Ability to efficiently manage claim denials ● Experienced and efficient in backlogs management. ● Complete understanding of Managed care contract ● Knowledge of MCO, Medicare, Medicaid and commercial insurances. ● Working experience of changing and fast-paced medical care environments. ● Detail-oriented and competent at reviewing records for accuracy, completeness and compliance with regulations. ● Expertise in Electronic Medical Record (EMR) software ● Medical Insurance Claims processing & denials ● EHR- All scripts, Next Gen, Cerner, Practice Fusion

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  • Electronic Health Record
  • Medical Procedure Coding
  • Medical Terminology
  • Accounts Receivable
  • Medical Mastermind Medical Billing Services
  • EMR Data Entry