Anusha James
Ballynacally
Summary
Results-driven Healthcare Information Systems and Revenue Cycle Management Specialist with over 10 years of experience in clinical coding, health insurance auditing, and EHR/HIS implementations across the Middle East (UAE, Qatar), and Ireland. Expertise in ICD, CPT, SNOMED, and DRG validation, with proficiency in Cerner Millennium, SAP HIS and Allscripts. Proven track record in optimizing revenue cycles, reducing claim rejections through audits, and ensuring compliance with MOPH, DOH, and HIPAA standards. Skilled in clinical documentation improvement (CDI), physician training, and stakeholder collaboration with insurers and IT teams. Certified AAPC Professional Coder (CPC) and currently pursuing a Master’s in Health Informatics at the University of Limerick, combining technical and analytical skills to enhance healthcare operations.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Clinical Research Assistant
University of Limerick
Limerick
08.2024 - 05.2025
- Collaborated with Johnson & Johnson's WiSTEM2D Programme to drive STEM research and innovation.
- Coordinated meetings between J&J and University of Limerick for effective collaboration.
- Participated in screening and selection of program awardees, ensuring adherence to criteria.
- Acted as primary contact from UL, maintaining professional communication with awardees.
- Managed timelines, milestones, and deliverables for various research projects.
- Supported collaborative research by working closely with faculty, researchers, and students.
- Maintained detailed records of research activities, findings, and methodologies.
- Conducted data collection and analysis, ensuring accuracy and meticulous attention to detail.
Medical Auditor/Health Insurance Officer/Clinical Coder
Alfardan Medicals with Northwestern Medicine
Doha
07.2022 - 08.2024
- Assigned international vocabularies to hospital procedures and costing for accurate documentation.
- Audited inpatient charts against diagnoses and procedures prior to insurance claim submission.
- Participated in Clinical Information System implementation as SME for Health Information Management, Revenue Cycle Management, and Patient Administration modules.
- Managed HIM and RCM masters within Clinical Information System, overseeing pricing and clinical vocabularies.
- Guided physicians and allied health professionals on Clinical Documentation Improvement strategies.
- Trained revenue cycle management department on clinical coding updates and enhancements.
- Prepared documentation for new medical procedures and lab tests for MOPH approval as requested by physicians.
- Developed audit strategies to reconcile unjustified rejections and followed up with insurance companies.
Health Information and Clinical Coding Specialist
GWC Logistics for Primary Health Care Corporation
Doha
03.2021 - 12.2021
- Led HIM department functions across health centers in Qatar, collaborating with center heads and clinical leads to ensure compliance with legal and regulatory requirements.
- Supported design of clinical information systems by analyzing current systems and recommending necessary changes.
- Participated in quality improvement projects focused on enhancing documentation accuracy while addressing coding-related issues with physician groups.
- Monitored Master Patient Index accuracy across all health centers to maintain reliable demographic information.
- Designed clinical documentation forms, guiding practitioners to complete documentation efficiently.
- Analyzed and generated medical reports for physicians and administrators, ensuring data relevance and clarity.
- Collaborated with onsite and client teams to implement system changes, conducting unit testing and managing defect resolution processes.
- Ensured compliance with federal regulations, providing training and support to staff on technologies and procedures.
Healthcare Revenue Cycle Officer
Aster Hospital, DM Healthcare Group
Doha
01.2021 - 03.2021
- Executed hands-on coding for redacted patient charts to ensure accurate diagnosis and procedures using Hospital Information Systems and manual forms.
- Assigned appropriate diagnosis, procedure terminologies, and drug codes in accordance with Standard Provider and Insurance Contracts.
- Facilitated coding reconciliation processes as liaison between coding team and physicians.
- Developed and delivered training for current and new physicians on coding practices.
- Processed insurance claims, conducted medical code verifications, and documented insurance payments while managing rejections and resubmissions.
- Coordinated pre-approval processes with insurance companies to secure necessary authorizations for medical services.
- Managed payment reconciliation and assisted in denial management to streamline resubmissions.
- Collaborated with finance department to track rejections and establish KPIs for monitoring insurance cash flow.
Senior Medical Coder
Catenate Solutions
Trivandrum
02.2017 - 03.2019
- Executed hands-on coding of redacted patient charts to determine accurate diagnoses and procedures.
- Performed medical coding assignments, ensuring correct application of ICD and CPT codes.
- Demonstrated proficiency in ICD-10-CM, CPT, ICD-10-AM, ACHI, HCPCS, and Drug Management Coding.
- Conducted coding and clinical reviews for medical necessity of claims in pre-payment stage.
- Reviewed and validated claim information, ensuring accuracy of member, provider, and plan details.
- Managed patient treatment, diagnosis, and procedural data to support accurate coding.
- Manually encoded medical terms not captured by data management systems.
Clinical Systems Specialist / Clinical Coding Specialist
LLH Hospitals, VPS Group
Abu Dhabi
06.2012 - 04.2015
- Assisted Business Transformation in the hospitals effectively from Paper transaction to Electronic, by deploying the Hospital Information System and Electronic Health Records.
- Steered implementation of SAP-HIS as Enterprise Application in the Group, involving development of Blueprint of AS-IS & TO-BE Business Process Analysis in ASAP Roadmap, and SAP Process Standardization.
- Supported acquisition of hospital / department specific clinical information systems, supported by committees and task forces.
- Designed, developed and implemented Insurance based Revenue Cycle Management system based on Department of Health, Abu Dhabi guidelines.
- Review the clinical documentation of the cases and identify the missing opportunities of severities.
- Query the physician to complete the documentation efficiently.
- Approach and discuss with major stakeholders in handling the cases in day-to-day duties.
- Show high level competencies of ICD-10-CM and CPT codes, ICD-10-AM and ACHI codes, HCPCS codes and Drug codes, coding guidelines and impact of severities.
- Work on DRG quality assurance, DRG validation, and provide team education and second level case review.
- Concurrent review of medical record documentation for working DRG and final DRG.
- Act as liaison in coding reconciliation process between coding team and physicians. Communicate effectively with coding team.
- Submitted and processed insurance claims, conducted medical code verifications and assessments, processed and documented insurance payments and reconcile the rejections and processed the resubmissions.
- Assign and report only the codes and data that are clearly and consistently supported by health record documentation in accordance with applicable code set and abstraction conventions, rules, and guidelines.
- Worked in a fully equipped Multi Specialty hospital which 90% of transactions are Insurance -Based under fast and target oriented processes.
- Assist in the pre-approval process and coordinate with insurance companies to obtain pre-determination, pre-authorization, and pre-approval for medical services.
- Reconcile payment advice and assist in denial management.
- Closely work with finance department to monitor rejections and develop and measure kpi's to monitor insurance-based cash flow, to facilitate easy management of healthcare facility.
- Assist in the development of physician education for current and new physicians.
- Member of various sub-Committees and Working Groups governing facility and regulatory strategy, projects, and initiatives.
Senior Business Process Executive
Honeywell Technology Solutions Lab
Bangalore
05.2011 - 11.2011
- Processing orders for Aircraft on Ground customers.
- Creating reports for customers for open orders.
- Contacting warehouse to confirm receipt of Honeywell parts.
- To make sure all the Email and Fax requests are completed within the Turn Around Time (TAT).
- Liaising with the warehouses of Honeywell to recover Honeywell parts on time.
- Sharing the team with the business updates from clients.
- Keeping abreast with the latest pricing of Honeywell parts.
Senior Process Executive
Infosys BPO Ltd
Bangalore
09.2008 - 04.2011
- Providing web-based support to the client.
- Responsible for delivering financial reporting within agreed timeframes, while complying with, generally accepted statutory requirements and client guidelines.
- Processing the client's data which includes Order Management (on Oracle 11i) and to provide a financial and quality-based non-voice servicing facility to the customers by ensuring delivery of complete and accurate information.
- Anticipating new customer needs, ensuring high delivery levels and customer satisfaction with higher level quality.
- Help with product availability, customer-service, and quality control related issues.
- Auditing and giving training to the new joiners.
Education
Master's - Health Informatics
University of Limerick
Limerick, Ireland08.2024
Master's - Business Administration
Alagappa University
IndiaBachelor's - Biotechnology
Kerala University
IndiaCertified Professional Coder - Medical Coding
AAPC
USATrained Professional Medical Auditor - Medical Auditor
AAPC
USASkills
- Hospital information systems: Cerner Millennium, SAP HIS, Allscripts
- Pharmacy management systems: Insta Practo, Green Rain
- Revenue cycle management: Insta Practo, Oracle
- Enterprise resource planning: SAP
- Customer relationship management: Salesforce
- E-claim management systems: Greenrain, Oracle Insurance Management System, INSTA
- Diagnosis terminologies: ICD CM, ICD AM, ICD WHO, SNOMED
- Procedural terminologies: CPT, ACHI, ICHI, OPCS, LOINC
- Consumables and drug coding: HCPCS, National Drug Codes
- Coding rules and guidelines: Coding Adjudication Rules, Clinical Coding Guidelines
Professional Highlights
- Poised to step into the position of Health Insurance & Revenue Cycle | Electronic Medical Records | Clinical Information System | Health Information Management | Clinical Coding Specialist.
- Experienced hospital information systems professional and clinical coder, CPC certified, with a track record of implementing and operating healthcare revenue cycle management processes, master patient index, ordering and billing processes, and electronic medical records and healthcare services, including laboratory, radiology, and pharmacy systems under tight deadlines with Alfardan Medicals, Northwestern Medicine, PHCC - Qatar, Aster Hospital - Qatar, Catenate Solutions - India, and LLH Hospital, VPS Group, Abu Dhabi-UAE
- I have a total of more than 10 years of experience, out of which 8 years are in healthcare organizations in the Middle East (UAE and Qatar)
Personal Information
- Passport number: Y2830342
- Date of birth: 03/28/88
- Nationality: Indian
- Visa status: Stamp 1G
Certification
- Certified Medical Coder
- Certified Medical Biller
Availability
Available immediately
References
References available upon request.
Timeline
Clinical Research Assistant
University of Limerick
08.2024 - 05.2025
Medical Auditor/Health Insurance Officer/Clinical Coder
Alfardan Medicals with Northwestern Medicine
07.2022 - 08.2024
Health Information and Clinical Coding Specialist
GWC Logistics for Primary Health Care Corporation
03.2021 - 12.2021
Healthcare Revenue Cycle Officer
Aster Hospital, DM Healthcare Group
01.2021 - 03.2021
Senior Medical Coder
Catenate Solutions
02.2017 - 03.2019
Clinical Systems Specialist / Clinical Coding Specialist
LLH Hospitals, VPS Group
06.2012 - 04.2015
Senior Business Process Executive
Honeywell Technology Solutions Lab
05.2011 - 11.2011
Senior Process Executive
Infosys BPO Ltd
09.2008 - 04.2011
Master's - Health Informatics
University of Limerick
Master's - Business Administration
Alagappa University
Bachelor's - Biotechnology
Kerala University
Certified Professional Coder - Medical Coding
AAPC
Trained Professional Medical Auditor - Medical Auditor
AAPC
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