Hariharakumar Saisundar

Results-driven Medical Coding and Insurance Claims Specialist with over 10 years of progressive experience across hospital and clinical settings in Oman and the UAE. Proven expertise in ICD/CPT/HCPCS coding, pre-authorization, denial management, and large-volume claims processing. Adept at collaborating with clinical teams, insurance companies, and management to maximize revenue recovery and ensure regulatory compliance (HIPAA, DHA).

Experienced managing claims for multi-facility networks including 4 hospitals and 11 primary health centers.

Insurance Coding Executive & Claims Processor at NMC Hospital Al Ghoubra (Numa Health) (2021-11 – Present)

• Process and adjudicate high-volume medical claims, managing resubmissions and denials in full compliance with coding guidelines.
• Insurance & Coordinate pre-authorization requests as lead Insurance Coordinator, achieving seamless and timely claims approvals.
• Review accounts receivable reports, insurance contracts, and weekly/monthly financial reports to track revenue performance.
• Maintain up-to-date knowledge of MOH regulations, claims processing principles, and insurance policy changes.
• Evaluate data accuracy and quality within the HMS-SOLVER hospital management system.
• Collaborate with clinical and finance teams to achieve revenue targets through effective collections and billing management.

Medical Claims Coordinator at Reach Employment Services LLC (2019-10 – 2021-04)

• Managed end-to-end claim submissions for OP, IP, Day Care, and Emergency encounter types.
• Liaised with physicians to justify and resubmit rejected claims within stipulated turnaround times.
• Conducted claim audits, verified ICD codes against physical invoices, and converted data into XML for DHA Portal upload.
• Oversaw claim submissions for 4 hospitals and 11 primary health centers, ensuring compliance across all facilities.
• Resolved internal billing discrepancies and managed resubmission-level corrections.

Medical Insurance Specialist — Submission & Resubmission at NTT Data Services LLC (2016-01 – 2019-10)

• Decoded complex clinical terminology into DSL, CPT, HCPCS, and DDC codes using the DBPMS system.
• Downloaded and analyzed XML remittance files from DHPO; identified, sorted, and resubmitted rejected claims.
• Maintained 100% coding accuracy and quality standards across all assigned claims.
• Met and exceeded resubmission productivity targets across multiple insurance companies.
• Distributed OP and IP claim details from the coding team to respective processing units.

Medical Biller & Insurance Executive at Medcare Hospital (2012-09 – 2015-12)

• Prepared and reconciled outpatient billing, separating cash and insurance payments.
• Updated inpatient bills, processed settlements, and coordinated emergency approvals and discharge procedures.
• Prepared cheque refunds for deposited patients and managed cash for internal lab and external blood sample requirements.
• Assisted Insurance Coordinator with pre-approval processing and daily admission system updates.

Cashier cum Billing Officer at Apelle Billing Systems (2011-05 – 2012-06)

• Managed billing operations, customer payments, and peak-hour queue management.
• Coordinated with team members to ensure smooth shift handovers and accurate transaction records.

Executive Accounts / Credit Officer at Ashok Leyland Finance Ltd & PS Acoustiks (2004-01 – 2011-12)

• Managed credit assessments, account finance coordination, and financial reporting analysis.
• Supported marketing initiatives, team communications, and on-time delivery of products and services.

Master of Business Administration (MBA) in Finance – Madurai Kamaraj University (2007)

Bachelor of Business Administration (BBA) – Madurai Kamaraj University (2004)