Dev Patel
Ontario
Summary
Motivated and highly organized coding and healthcare professional with over 2 year of experience backed by comprehensive knowledge of ICD-10-CM/PCS, MS-DRG and APR-DRG assignment, and CMS guidelines. Proven experience in accurately analyzing medical records to ensure documentation integrity, support accurate coding, and enhance healthcare quality metrics. Adept at working collaboratively with clinical staff to drive continuous improvement in documentation practices and patient care outcomes.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Clinical Inpatient Appeals Auditor
Prime Healthcare
07.2024 - Current
- Review clinical documentation, coding, and billing records to evaluate the validity of payer denials and prepare appeal letters for claim reconsideration. Identify and resolve issues related to DRG downgrades and clinical validation denials. Utilize clinical knowledge to defend coding decisions by referencing authoritative guidelines, clinical indicators, and physician documentation. Collaborate with the legal team to develop Administrative Law Hearing accounts, attend hearings, and participate in peer-to-peer meetings, contributing to effective resolution strategies in complex denial cases. Draft and submit comprehensive appeal letters within payer timelines, ensuring documentation supports accurate coding. Conduct denial root cause analysis and provide feedback to improve documentation, coding quality, and appeal readiness.
Clinical Documentation Coder Auditor
Prime Healthcare
11.2023 - 06.2024
- Review inpatient and outpatient medical records to ensure the clinical documentation accurately reflects the patient’s diagnoses, treatments, and services rendered. Collaborate with physicians, nurses, and coding professionals to clarify documented data for accurate diagnosis-related group (DRG), severity of illness (SOI), and risk of mortality (ROM) assignment. Develop, submit, and analyze physician queries to clarify documentation in support of accurate ICD-10-CM/PCS coding, DRG assignment, and quality core measures. Identify opportunities for improvement in chart documentation, including specificity of principal diagnosis, comorbidities, procedures, and Present on Admission (POA) indicators. Analyze trends in documentation and coding to identify opportunities for process improvements. Assist in creating and reporting performance metrics related to documentation accuracy, query response, and case mix index.
CDI Retro Auditor
WellMed
01.2023 - 04.2023
- Perform detailed retrospective reviews of inpatient and outpatient medical records to assess the accuracy and completeness of clinical documentation and ICD-10-CM/PCS code assignments. Audit coded records post-discharge to validate Diagnosis Related Group (DRG) assignments, risk adjustment factors, and documentation consistency in accordance with official coding guidelines and payer requirements. Identify discrepancies between documented care and coded diagnoses/procedures, and issue retrospective queries to clarify ambiguous or incomplete documentation. Prepare comprehensive audit reports outlining findings, recommendations, and impact on reimbursement, quality metrics, and compliance.
Public Health Field Experience (PHFE)
Moffitt Cancer Center
01.2020 - 04.2020
- Participated in a Public Health Field Experience at Moffitt Cancer Center in Tampa, focusing on Breast Cancer prevention research. Acquired knowledge of policies, fundamentals, diagnosis, and screening guidelines, collaborating with the public health department. Evaluated existing health promotion programs within the hospital, identified barriers, and assessed hospital-run services. Developed and distributed informative 'breast cancer infographics' to raise awareness about early detection, misconceptions, and management. Successfully obtained IRB approval for the study and delivered a presentation on breast cancer and public health to hospital staff.
Intern & Trainee
Mayflower Hospital
03.2016 - 06.2016
- Conducted consultations and assessments for both inpatients and outpatients, including diagnosing medical conditions, ordering necessary tests, and devising treatment plans. Engaged in routine medical record-keeping, maintained collaborative relationships, and regularly consulted with peers. Committed to ongoing medical education (CME), patient education, and delivering specialized care.
Junior Resident Medical Doctor
G.K. General Hospital
06.2015 - 01.2016
- Conducted comprehensive physical examinations, administered standardized physical tests, and made assessments, diagnoses, and treatment medication prescriptions for patients. Supervised and trained a team of 5 medical students in specialized procedures and activities. Acted as a tutor in community medicine programs for medical students, patients, and their families. Provided hands-on patient care, managed medical records, explained procedures and treatment plans, and facilitated specialist referrals. Proficient in surgical ward procedures such as incision and drainage, wound care, pre/post-op care, and blood transfusions. Responsible for ordering, performing, and interpreting test results and examination findings. Collaborated regularly with patient support advocates and nursing staff to ensure comprehensive patient care. Diligently monitored patient conditions and offered chronic disease management.
Intern Doctor
G.K. General Hospital
03.2014 - 03.2015
- Engaged in shadowing and direct patient interaction, gaining experience in patient history taking. Conducted physical examinations, assisted in minor surgical procedures, and provided support during major surgeries. Proficient in performing biopsies, Naso-gastric Tube Insertion, Cardiopulmonary resuscitation, intubation, and catheterization. Took on a role as a tutor and lecturer for undergraduate medical students. Conducted research, collected data, and analyzed mortality rates between hospital newborns and referrals, presenting findings to hospital leadership for improved understanding of the admission process.
- ETS-MBA Major Field Test (89th Percentile in US) - Jul 2023
- Crisis Management Seminar - Mar 2023
- Applying CDC guidelines for Prescribing Opioids: Motivational Interviewing - Nov 2019
- Crisis and Emergency Risk Communication (CERC) - Nov 2019
Education
Master's - Business Administration
Jacksonville University
07.2023
Master's - Public Health
Nova Southeastern University
03.2020
Bachelor of Medicine and Bachelor of Surgery (MBBS) - undefined
Gujarat Adani Institute of Medical Sciences
03.2016
Skills
- ICD-10-CM/PCS coding & CPT/HCPCS expertise, MS-DRG & APR-DRG assignment, Clinical validation and query writing, Strong understanding of EHR (Epic, Meditech etc), Case mix index analysis & Risk adjustment (HCC, SOI/ROM), Denial management, Appeal writing & regulatory defense, Peer-to-peer and Administrative Law Hearing participation, Interdisciplinary collaboration (legal, CDI, Provider), CDI tools (3M, Optum), CMS, Medicaid, and Medicare guidelines, Coding Clinic & Official Guidelines for Coding & Reporting
Certification
Certified Coding Specialist (CCS), Certified Documentation Integrity Practitioner (CDIP), ETS- Major Field Test MBA 89th percentile in US (2023)
Timeline
Clinical Inpatient Appeals Auditor
Prime Healthcare
07.2024 - Current
Clinical Documentation Coder Auditor
Prime Healthcare
11.2023 - 06.2024
CDI Retro Auditor
WellMed
01.2023 - 04.2023
Public Health Field Experience (PHFE)
Moffitt Cancer Center
01.2020 - 04.2020
Intern & Trainee
Mayflower Hospital
03.2016 - 06.2016
Junior Resident Medical Doctor
G.K. General Hospital
06.2015 - 01.2016
Intern Doctor
G.K. General Hospital
03.2014 - 03.2015
Master's - Public Health
Nova Southeastern University
Bachelor of Medicine and Bachelor of Surgery (MBBS) - undefined
Gujarat Adani Institute of Medical Sciences
Master's - Business Administration
Jacksonville University
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