1. PRASAD BUCHI
Mobile: +971 50 471 0994 ~ E-Mail: bnvvprasad@gmail.com
Achievement-driven professional seeking senior level assignments in Insurance/Coding & Billing/ Revenue
Cycle Operations with a leading organization of repute preferably in ITS sector
15 years of dynamic career reflecting pioneering experience and record breaking performance in driving Coding & Billing
process pertaining as per Standards
PROFILE SUMMARY
· A dynamic professional with extensive experience in Insurance, Coding & Billing and Revenue Cycle Operations
· Well experienced in HIM Coding, Billing, Insurance and Claims process under various platforms with extensive
experience under Hospital & Practice Management.
· Adrift in HIM & revenue cycle processes, Billing & E-Claims, Process integration, EMR, coding, processes transitioning,
authority regulations & billing requirements, Six Sigma Methodology and MR documentation
· Adept in maintaining efficient documentation as per local authority regulations & billing requirements
· A Visionary & High-Performance Management Executive, with expertise in validating data in different areas and
transcribing which involves transitioning new processes and stabilizing the same for smooth operations
· Skilled in carrying out inpatient, outpatient & ambulatory service charge entry, electronic & manual processing of
claims and payment entry from EOBs & ERAs, claim correction and reconciliation.
· Skilled in carrying out development of periodic reports for clinical staff and recognizing unbilled charges due to
inadequate documentation.
· Steering role in handling the unpaid claims from insurance companies for various denial reasons, claim correction and
resubmission in specified time limits
· Significantly involved hospital revenue enhancement and various departments like Insurance, Finance & HIM
· Possess extensive experience in identifying documentation requirements, acquiring authorization, pre-approval
request and claim correction/modifications & price negotiations.
· Proficient in managing, motivating and leading teams for running successful business process operations with proven
ability of achieving service delivery/process targets
· Adroit at maintaining cordial relationship with customers, ensuring quality and service norms thereby achieving
customer satisfaction and business retention
· Motivational management style with record of building & retaining highly motivated teams & prestigious key accounts
· Demonstrated excellence in carrying out quantitative & qualitative auditing and developing electronic health records,
transition from physical (paper) records to electronic, voice transcription implementation
· Adept in imparting training on documentation to doctors and other healthcare professionals
· Delivered a dynamic breakthrough by setting-up quality standards, ensuring high-quality customer experience, while
adhering to SLAs and work processes
· Exceptionally well organized and detail-oriented with an ability to meet deadlines
WEALTH OF EXPERTISE
~ Insurance ~ HIM & Medical Coding ~ Billing & E-Claim Process ~ Account Receivables ~ Denial
Management/Analysis & Resubmission ~ IT Support ~ EMR Implementation ~ Process Transition &
Enhancement ~ Team Management ~ Operations ~Revenue Capture & Enhancement ~Flaw Identification ~
Rectification ~ Process design & Implementation ~
Conversant with the following:
· HAAD/DHA/SCH Policies and Guidelines & CMS/AMA/CCSC Process guidelines
· All major insurance company policies and guidelines, payment methodologies (fee for service/DRG/per diem)
· Medical Coding - ICD-9-CM, ICD-10-CM & PCS, CPT, ICD-10-AM & ACHI, CDT, CDA/ADA, & HCPCS, APC, IR & MS
DRG), HCC Coding and SNOMED CT
· Billing & E-Claims – US & UAE Billing process & systems
· Billing Applications - GE Centricity, Mysis Tiger, IDX, Cerner Softmed, ClinTrac, Medron, Office Ally, ERP, Hospycare
· Billing Types- Facility (DRG)/ Physician (Fee for Service, Per Diem) / ASC / LTC / Pain Mgmt. / Chemotherapy etc.,
Skilled in:
· Carrying out insurance billing, cash billing & corporate billing
· Preparing & submitting (manual or electronic) and coding insurance claims accurately
· Tracking and updating on systems - ICD 9-CM, ICD 10-CM, CPT, CDT, HCPCS and DRGs (IR & MS) on a regular basis
· Implementing insurance eligibility checklist and verification process
· Developing an application within HIS enabling users to identify the potential areas of errors before patient is
registered and also before submission of claims
· Performing prompt posting of payments and reconciliation process
· Designing and preparing customized monthly statistical and analytical dashboards for data tracking and operational
purposes
· Handling data accuracy enabling data management at operations and finance departments for resource utilization,
patient wise revenue Vs costs effectively

2. · Designing work flow processes and IT support for Hospital Information Systems for effective documentation, data
capture
· Reducing variances between finance/accounts & claims
CAREER MILESTONES
· Significantly functioning as the Active Member for:
o Revenue Cycle Steering Committee at Al Noor & Lifeline
o Established effective Coding & Billing dept. & processes
o Implementation of Coding process & designed effectively state-of-art coding-billing process.
o Accomplishing JCIA for hospitals Al Noor & Lifeline Healthcare
o Clinical Coding Steering Committee and Coding arbitration, HAAD -Abu Dhabi,
o Designed and implement effective HIS-EMR system
o Designing coding / billing HIS-IT (ERP) System for effective billing/claiming process
o Process integration for better process, effective staffing and cost controls.
· Accredited for transitioning process of HIM/coding in compliance to HAAD/DHA/SCH Standards in UAE and Qatar
· Steering role in designing the process flow for inter-departmental (PSD/Admission office – HIM – Insurance) process
flow for timely billing
· Acknowledged with the Letter Appreciations from corporate management on Reducing Variances in Billing Vs Hospital
Expanses Project
· Recognized with Letter Appreciations for minimizing the variances between Hospital Finance System (ERP) Vs eClaims
· Flourishingly completed project on:
o Effective Usage of Consumables (Purchase-Request-Dispatch-OR utilization-HIS-Coding/Billing)
o EMR interface and Billing Process – User Friendly System Design
o Laboratory/Radiology Inter-Departmental HIS Work Flow - Starting from Registration/Order-Service-Prior
Authorization-Results-Claims
o HIM & Hospital Information System – Coding & Billing System Development according to internal processes and
migration projects from physical to electronic record management & claims
· Significantly delivered a seminar on DRG Coding (Importance – Applications) & the Basis Requirements Vs Hospital Revenues
ORGANISATIONAL EXPERIENCE
Since Feb’13 Lifeline Healthcare, Dubai, UAE as Manager – Insurance, HIM Coding & Billing, E-Claims
Sep’12 to Jan’13 Primary Healthcare Corporation (PHCC), Doha, Qatar as Sr. Coordinator - Coding /
HIM Implementation
May’09 to Aug’12 Al-Noor Group of Hospitals Airport Road, Abu Dhabi, UAE as Manager - Medical
Records (HIM) & Coding (Billing & E-Claim Processing)
Jul’08 to Feb’09 Revenuemed India Ltd, Trivandrum as Coding Manager – Operations
Jul’07 to Jul’08 Nspire Synergy Solutions Pvt. Ltd., Hyderabad as Manager - RCMS
Apr’06 to Jun’07 Promantra Synergy Solutions Pvt. Ltd, Hyderabad as Assistant Manager - Coding
Jan’05 to Mar’06 Infrahealth India Pvt. Ltd. / Oasis Mediscript Pvt. Ltd., New Delhi as Project Leader -
Coding/AR
Accountabilities:
· Handling entire gamut of HIM & revenue cycle processes and recognizing areas of enhancement
· Executing adequate measures for maximization of customer satisfaction level
· Monitoring the activities pertaining to work allocation and training & recruitment
· Administering the overall daily operations of organizational unit and ascertaining compliance with laws, policies & regulations
· Developing standard operating procedures ensuring SLAs
· Accountable for migration of systems to upgraded versions for attaining maximum efficiency in various operations
related to EMR, coding/ billing
· Heading the process improvement initiatives
· Identifying client’s requirements and developing, implementing & transitioning the processes accordingly
· Developing & implementing workflows for facilitation of structured support in all areas & issues
· Responsible for planning & organizing in-service programs for patient care process
· Maintaining track of DNFB and ensuring it as per the agreed range
· Performing quality control studies of coding and other aspects of billing
· Maintaining medical records and identifying & correcting problems
· Executing quality control audits through Six Sigma Methodology
· Supporting physicians/providers in matters pertaining to MR documentation, coding, billing and insurance policies

3. · Accountable for identification of prospective insurance companies, review of agreements, price negotiation and
contracts finalization
· Ensuring compliance to Insurance policies & protocol as per agreement
· Interfacing with Insurance Companies to ensure approval of problematic cases
· Recognizing the exhausted benefits in coordination with Re-submission Team for maximum recovery from Insurance
companies
· Carrying out Insurance disallowance write-offs in collaboration with Accounts Receivables Department after proper
reconciliation
· Evaluating the disallowance reasons, recognizing enhancement areas identified and implementing the changes
· Ascertaining timely submission of Insurance department statistics on a monthly basis
· Assisting the credentialed and supervisory staff in continuing education efforts and encourages meetings
· Carrying out evaluation, educating and enhancement in the quality of health information
· Recognizing the productivity and quality standards according to departmental & organizational guidelines
· Developing reports and appropriately utilizing the findings of performance improvement activities of HIM services
· Serving as the active member of Hospital Governance Committees, Management Information Systems,
Documentation Improvement Committees, Hospital-wide Performance Improvement Committees, Revenue Cycle
Review Committees, Enterprise wide Electronic Medical Records (EMR) Committees, Accreditation Committees and
Investigation and Review Board for Research Management
PREVIOUS EXPERIENCE
Apr’04 to Dec’04 Omega Heath IT Solutions Pvt. Ltd. Hyderabad as Sr. Medical Coder (QC)
Oct’03 to Mar’04 Apollo Health Street Ltd., Hyderabad as QA MR/Tr. Medical Coder
Mar’01 to Sep’03 Emergency Dictating Software Services Ltd., Hyderabad as QA / Reviewer (MT)
Oct’99 to Feb’01 Innovative Datamatics Ltd. & ETOS, Hyderabad as Proof Reader (MT)
CERTIFICATIONS
· Certified Professional Coder (CPC) awarded by American Academy of Professional Coders
· Certificate of Appreciation on Seminar on DRG Importance & Applications
TRAININGS/CONFERENCES
· Attended the following:
o HIMSS ICD 10 CM / PCS Workshop, Abu Dhabi-UAE
o ICD-10-AM Certificate of Attendance by representative from WHO, Doha-Qatar
o HIM Conference, Abu Dhabi – UAE
o CCSC Certification on Coding E&M for OP, Emergency Dept., Home Care, etc.
o 80-hour comprehensive training program from PMCC certified trainer (Regina A. Blakeslee, RHIA) for CCS (AHIMA)
o 6 months comprehensive training program in Medical Transcription by ETOS School of Medical Transcription, Hyderabad
o Imparted training to candidates on Coding Certifications (CPC, CPC-H, CCS, CCS-P & CCA)
IT SKILLS
Well versed with:
· GE Centricity, Mysis Tiger, IDX, Kareo & Hospycare
· Medron, LanVision and HIS
· Cerner Softmed/ClinTrac/Power Chart, ERP
· Ingenix EncoderPro, WinStrat and 3M Encoder
· MS Office and Windows 95/2000/XP/7
EDUCATION
2012 MBA (Healthcare Management) from ISBM, Hyderabad
2000 PG Diploma in Computer Applications from Indotronic, Hyderabad
2009 B.Tech. (Specialization) from College, Location
PERSONAL DETAILS
Date of Birth: 25th August, 1976
Address: PO Box 49866, Dubai-UAE
Languages Known: English, Hindi and Telugu