Vishal Bali

Vishal Bali has 12+ years of experience in Healthcare Payer and Provider Domain. A well-diversified portfoliconsisting of Solution Designing, Product Management, Medical Coding, Billing, Medical Transcription, Medical Records Summarization (LPO), Medical Policy Automation, etc. He has conducted training sessions tincrease the domain, tool and process expertise of the team. He possesses excellent interpersonal skills in communications and client relations.

Skills

• Vishal’s Functional Expertise includes Healthcare Payer and Provider Domain, Medical Coding,  ICD-10, Remediation, RCM, Auditing and Claims Adjudication.
• His Technical Expertise includes extensive experience with following tools: MS Office, Claims   Manager 4.0, iCES 1.4, Content Manager, iCRM
• Certified by American Health Information Management Association and American Academy of Professional Coders.
• Claims Adjudication Rules on iCES 1.4 and Claims Manager 4.0 based on Knowledge Base and Content Manager and ICD-10
• LCD/NCD/CCI edits on Claims Manager based on Content Manager and Knowledge Base and RCM
• Medical Coding - ICD-9, ICD-10, CPT, HCPCS,HCC and SNOMED
• Medical Summary for Medical Underwriting (life insurance)
• I-CRM, Content Manager, Claims Manager 4.0, iCES 1.4, HL7 and Contract Manager

Work experience

• Training and educating associates in various medical specialties
• Assigning and QA review of the codes
• Elicitation of requirements from onsite counterparts and explain them toffshore team members
• Task allocation tvarious offshore team members along with the necessary guidance required for concluding the task and tracking them tclosure
• Delivering Healthcare & Process related trainings and guidance tvarious existing team members & new joiners joining the project
• Responsible for overall process health of the project and handling monthly PCI audits
• Delivering Healthcare & Process related trainings
• The role alsinvolves end tend coordination with HCL onsite resources with their issues and challenges
• Project related tthe clinical interpretation of Local Coverage Determinations and National Coverage Determinations existing on CMS and contractors for CMS websites and development of clinical edits involving CPT, ICD-9, modifiers, POS, TOB/Revenue codes, frequency
• Worked on DME policies, PQRI from CMS, Medicaid policies, and Knowledge Base edits based on CCI edits and various resources
• Research and development of i-CRM tool which is a crosswalk for ICD-10 remediation
• Developing coding and clinical rules required by i-CRM tool for historical data analysis
• Implementation of i-CRM tool for ICD-9 tICD-10 crosswalk in the applications of Payer and Providers
• Undertaken education and training of employees at the client end for ICD-10

Certification

• Certified Coding Specialist from American Hospital Information Management Association – 2010
• Certified Professional Coder (Provider) from American Academy of Professional Coders - 2003
• Certified Professional Coder (Hospital) from American Academy of Professional Coders – 2008
• Certified Professional Coder (Payer) from American Academy of Professional Coders – 2009
• Advanced Network Centered Computing (1-1/2 years) from NIIT – 1998
• ‘O’ level certificate from DOEACC (1-year) - 1992

Achievements

• O2, Outstanding Annual Performance, HCL, 2011.
• Knowledge Base, Healthcare Payer Domain, Genpact, 2009
• Innovation Award, Healthcare Payer Domain, Genpact, 2008
• Lean Ace Award, Healthcare Payer Domain, Genpact, 2007
• Train the Trainer Award, Medical Coding, Alpha Thought Technologies, 2004
• AHIMA AND AAPC MEMBERSHIP