Keep in touch with meI'm using Intch to connect with new people. Use this link to open chat with me via Intch app
Work Background
The Applied AI Company (AAICO)Machine Learning Analyst- TL
Oct. 2022 - Feb. 2023Abu Dhabi Emirate, United Arab EmiratesWorked with a team of ML Analysts to drive ML system's training, tuning, and testing of the model to improve the decision making for "Healthcare Documentation Analysis" from unstructured texts, and then actioning the decisions it suggests ensuring the highest safety standards built in to meet the "healthcare & insurance regulations" for AI technology. AI Models were fine tuned using reinforcement learning from human feedback (RLHF) to become more helpful, less harmful, and show a huge leap in performance.
Mediclinic Middle EastRCM Officer
Nov. 2016 - Sep. 2022Abu Dhabi, United Arab EmiratesWorked as “RCM Officer (Coding Supervisor)” for diverse roles as below:
Supervision of a team of 20 certified coders for production and quality of outpatient and inpatient facility claims processing. Nature of job extends to hospital queries related to Medical Billing, Medical Coding, and Insurance coverage (Policy, Approvals, copays, and deductibles et cetra).
Direct submission and resubmission of claims to HAAD post office (Shafifiya) after pre-submission corrections. Training and Education to Doctors, Coders, and Nursing staff on “Medical Coding, Billing, Insurance & HAAD guidelines.
Analysis of rejected claims and requesting resubmission with required changes.
Claim analysis for any potential revenue leakages through improper documentation or lack of documentation and reporting to management for prompt actions.
Al Noor Hospitals GroupCertified Professional Coder
Oct. 2011 - Oct. 2016Al-Ain, Abu Dhabi, United Arab EmiratesWorked as a certified professional coder for multiple roles as below: Audit and review of CPTs and DXs. Feedback to doctors and nursing staffs on medical necessity and accurate reporting/documentation. Feedback to fellow coders on their production and quality of work. Coordinating with supervisor and manager on important communications, business reporting through advanced excel and power-point presentations, and key decisions. *Skill sets: Claims Audit for correct CPTs n ICDs.
Medical Necessities.
Denial & Rejection Analysis.
Clinical Documentation Improvement.
GenpactBusiness Analyst
Dec. 2007 - Sep. 2011Gurgaon, IndiaA) Worked as a “Clinical Quality Analyst” since Jan 2011 to Sept 2011 for a Software Testing Project. This team was responsible for testing of various clinical components of US Healthcare software products to be used by both “Payors as well as Professionals” for accurate payment or reimbursement related issues. Primary responsibilities:
Individual responsibilty to comprehend various clinical rule logics (custom and system based) used by software developers while developing or upgrading any software product.
Individual responsibility for creation of clinical test cases basis rule logics used in the software development or upgradation for sprint-based projects to evaluate both positive and negative aspects of a software functionality.
Script-based IMF/EMF generation on QTP (Quick Testing Professional) for testing. IMF/EMF import to Oracle or SQL application (TOAD/SQL script runner).
Rule logic import and set up to software for component testing.
Unit Testing, Functional Testing, and Integration Testing.
Troubleshooting and Final rule logic pass for the release of product. C) From April 2007 to Oct 2009 as a “Business Analyst and SME (Medical Coding)” for retrospective fraud investigation team in US and India. Primary Responsibilities: • Identification of providers participating in abusive and/or fraudulent reimbursement behavior.
• Data analysis of provider claim history to substantiate fraud and abuse allegations stemming from tips, subject matter experts, professional associations and other sources of fraud and abuse information.
• Data analysis of provider claim history to detect patterns of fraud and abuse across large provider populations.
• Managing each analysis to appropriate implementation or closure.
• Development of case strategies that take into consideration the legal, customer service and financial implications of each case.
Intch is a Professional Networking App for the Future of WorkSee more people like Sanjay on Intch
100k+ people
130+ countries
AI matching
Get Intch if you'd like to
54320 people
17
Project development manager @ peritum
26
Project Manager @ Archdesk
20
Field specialist; Business support analyst and content writer @ STEM HEALTHCARE , IAPWE
5411 people
15
Managing Director @ Resident Logic ConsultInc
38
Advisor, Board Director, Partner, Guide, CEO, Chairman @ Strategic Brand Solutions, Ulysees Holdings, Clean Air Associates
19
Senior Expert : business intelligence & analytics @ Federal Government