Dinu Kumar

 DINU KUMAR K K Sr. Medical Associate PERSONAL DETAILS Email id :- Skype ID : dinu.kumar687 Date of Birth: 5th October 1985 Nationality: Indian Marital Status: Married Permanent and Current Address: Kattilparambil House Eloor East Udyogamandal p.o Ernakulam (Dist) Kerala Pin - 683501 Passport No.: J- Residing Country: India Languages know: English, Malayalam, Hindi, Kannada, & Tamil Hobbies: Cooking, Listening Music, Bike Riding, Playing Cricket, and Travelling. Contact Details :-(mobile) EDUCATIONAL QUALIFICATIONS COURSE/EXAM PASSED UNIVERSITY PERCENTAGE Secondary School Leaving Certificate Kerala Board 61 % Pre-Degree(Science) Kerala Board 56 % Bachelor of Science in Nursing Rajivgandhi Health Science 58 % Medical Coding Completed(2017) Non Registered CURRENT REGISTRATION STATUS. CERTIFICATE NURSING COUNCIL CERTIFICATE REG.NO. Certificate of Reg. for Bachelor of Science in Nursing The Karnataka Registered Nurse And Midwife Council 031270 Certificate of Reg. Bachelor of Science in Nursing The Kerala Nurses And Midwives Council 15814 EXPERIENCE SUMMARY NAME OF THE EMPLOYER PERIOD OF THE EMPLOYMENT JOB TITLE HOURS WORKED/WEEK AREA Sunrise Hospital Kakkanad Cochin - to - Registered Nurse 48 hours Medical-Surgical, cardiology and pediatric ward Afcons Infrastructure Ltd Cochin 04 -06-2012 to - Registered Nurse 48 hours Emergency and Trauma Care VIMS Hospital,Bangalore - to- Registered Nurse 48 hours Medical-Surgical and cardiac ward Exl, Infopark, Cochin- to- Medical associate 48 hours Medical/Clinical Claim Review Cascade revenue management- to- Sr. Medical Associate 48 hours Eligibility Verification and AR calling Wave Online Cochin- to- Sr. Medical Associate 48 hours Clinical Claims review and Claim Adjudication Docgiant, Infopark, Cochin- to current Sr. Associate 48 hours Clinical documentation and Claim Adjudication PROFESSIONAL EXPERIENCE IN DETAIL 1 Since August 2019 to current as a Sr. Associate in Docgiant, Infopark, Cochin Review medical and surgical reports, as well as preparing medical document as per the evaluation. Reviewing medical records, case study, and electronic records. Decision taken as per client policies. Maintaining HIPPA rules. Responsible for the tracking, quality control and timely completion of the document components for complex medical writing projects. Working together with key client counterparts at clients locations to facilitate the completion of project and their appendices. Understanding new agreements and changes due to regulatory guidelines. Trained in writing regulatory documents such as CSRs (Clinical Study Reports), Protocols as per client guidelines. 2 .Since March 2018 to August 2019 as a Sr. Medical Associate in Wave Online, Cochin Profile: Working as Medical Claims Adjudicator in claims processing, accounts payable and general accounting. Reviewed electronic claims and processes data as required into the claims system, resolved computer generated correct conditions, and determined right payment. Researched and practice claim payment adjustments resulting from consumer service referrals, audited data incorrectness as detected. Exercised excellent judgment, interpreted medical claim data and contracts. Processes responses accordingly. Research and take action in response to telephone and written inquires. Send system generated letters to providers. Achieved joint effort, production and value standards so as to guarantee timely, well-organized and accurate claim processing. Accurately evaluate, regulate, and pass judgment of Medicare claims in a timely manner. Assessed, approved, and denied various medical claim requests received. Interpreted and followed government regulations and company policies, as applicable. Sound knowledge of medical terminology, coding, and billing standards Immense knowledge of various health insurance, HMO, and managed care principles Ability to comply with HIPAA and other applicable regulatory guidelines. Ability to review and submit medical claims, in a timely manner. 3 .Since March 2018 to August 2019 as a Sr. Medical Associate in Wave Online, Cochin Reviewed electronic claims and processes data as required into the claims system, resolved computer generated correct conditions, and determined right payment. Researched and practice claim payment adjustments resulting from consumer service referrals, audited data incorrectness as detected. Exercised excellent judgment, interpreted medical claim data and contracts. Processes responses accordingly. Research and take action in response to telephone and written inquires. Send system generated letters to providers. Achieved joint effort, production and value standards so as to guarantee timely, well-organized and accurate claim processing. Accurately evaluate, regulate, and pass judgment of Medicare claims in a timely manner. Assessed, approved, and denied various medical claim requests received. Interpreted and followed government regulations and company policies, as applicable. Sound knowledge of medical terminology, coding, and billing standards Immense knowledge of various health insurance, HMO, and managed care principles Ability to comply with HIPAA and other applicable regulatory guidelines. 4 .Since July 2014 to February 10 2017 as a Medical Associate in EXL, Infopark, Cochin Profile: Worked with one of the top 5 Health Plan Organization in the U.S as my client. Position as a Medical Claims Adjudicator with a reputed company. Enough experience in claims processing, accounts payable and general accounting. Review medical and surgical reports, as well as preparing medical document as per the evaluation. Reviewing medical records, case study, and electronic records. Decision taken as per client policies. Maintaining HIPPA rules. Responsible for the tracking, quality control and timely completion of the document components for complex medical writing projects. Working together with key client counterparts at clients locations to facilitate the completion of project and their appendices. Understanding new agreements and changes due to regulatory guidelines. Trained in writing regulatory documents such as CSRs (Clinical Study Reports), Protocols as per client guidelines. The use of several advanced project estimating, forecasting, and time –tracking mechanisms has facilitated a successful track record of delivering client services in a timely, thoughtful, and professional manner. Excellent project management and clear understanding of the guidelines of various regulatory bodies. Strong skills in areas of medical writing and also analytical and research skills. 5 .Since July 2013 to June 2014 worked as a Registered nurse in Vims Hospital, Marthahalli, Bangalore Main Duties and Responsibilities: Provide medications and injections as prescribed by the doctors Administer intravenous fluids and oxygen if required. Monitor vital signs like BP, Temperature, pulse etc and record it. Provide general nursing care to all patients. Give psychological support to the patient and family members. Educate patient and family about the disease and prognosis of the patient. 6. Since June 2012 to June 2013 worked as a Registered Nurse(Industrial Nurse) in Afcons Infrastructure Ltd Main Duties and Responsibilities: Maintain safety and well-being of the patients in accordance with safe. Maintains Patients Records as well All Documents Establish effective communication with all other members of the health care team and Workers. Psychological support to patients. Duties administering medicines and injection to the Patients Maintains patient’s clinical records, assist with execution of physicians orders Conduct Health Education Program for communicable disease. Weakly Health Check-up. Conduct Health Education Program for safety. 7 .Since October 2010 to December 2011 worked as a Registered nurse in Sunrise Hospital, Cochin. Main Duties and Responsibilities: Assess patients to identify appropriate nursing interventions. Administer medications and treatments as prescribed by a physician or according tob established policies and protocols. Preparation patients for their procedure involves ensuring pre-medication is administered, consent operation sign. Monitoring patient’s vital signs. Responsible to keep accurate records of symptoms, assessments, reactions, treatments and progress. Responsible for the management of pain and post-operative nausea and vomiting which are common post-operative side effects. Computer skills Windows, Ms- Office (Word, Excel, PowerPoint) & Internet Key Qualifications • Outstanding knowledge of claims processing and medical terminology. • Superb data entry skills with high accurateness. • Strong written and spoken communication skills. • Good computer skills. Objectives Seasoned professional, with planning, monitoring and resource-balancing skills and ability to handle multiple functions in high pressure environments, offering expertise in deciphering the true impact of any strategic decision with exceptional clarity while communicating the requirements and deliverables to the team members. Declaration I hereby declare that all the above furnished information’s are true and correct to the best of my knowledge and belief. Place: Cochin Date: DINU KUMAR K K