John Dsouza

• Ensuring proper coding/DRG cases are coded accurately as per the DHA unified list
• To Assist staff in elective cases if there is lack of documentation as per the requested services.
• To monitor long stay DRG cases to assist staff to update the insurer in timely manner so as to avoid difficulties in obtaining final approval after discharge time.
• To monitor strictly 48 hrs discharge time to ensure the staff update the insure in timely manner
• Staff allocation in done as per the requirement DRG setup.
• Ensuring Cpt codes are accurately billed according to the OR notes.
• Monitoring discharged cases where in severity disagreement is applicable and escalated to mgmt. for further discussion and closure of the cases in timely manner.
• Checking IP bills to ensure under billing or overbilling not done before patient discharge. 
• Ensuring all IP Cases where in cash/Insurance billing is done as per the standard billing rules of Insurance co and of the hospital.
• Preparing Duty Rota.
• Monitoring IP case flow by preparing statistic about the patient flow of insurance/cash patients
• Handling complicated cases and to ensure proper data forwarded to insurance co and to obtain approval in proper time frame.
• Updating /Orienting new insurance protocols and billing rules to the staff.
• Coordinating with Insurance companies for speeding up the approval process and Discharge cases as and when required.
• Ensuring the billing process being accurately done according to insurance company agreed tariff.
• Ensuring that before closing the final bill all procedures and the rounding fees are being billed as per contractual agreements.
• Keeping records of all communications done with ref to billing/insurance and to produce when required.
• Educating the doctors about the protocols of medical documentation wherein the revenue can be generated more.

Coordinating with the finance team if there any financial issues in terms of patient refund or doctor’s income share

EXPERIENCE:

Mediclinic city Hospital(Sep 2017 till date) 

• INSURANCE CORDINATOR

Dr. Sulaiman Al Habib Medical Group- Dubai (From june 2015 till Aug 2017)

• SR.INSURANCE CORDINATOR (Cum Incharge Billing/Insurance)

Mediclinic city Hospital(March 2 2011 till June 2015)

• INSURANCE ADMINISTRATOR

Zulekha hospital Dubai (December 2007 – March 2011)

• INSURANCE CORDINATOR

 

EDUCATION

MBA (Hospital Administration)

Jaipur National University.

Sharjah Branch.