Resbin Mohammed
Kingston,ON
Summary
Health and Dental Claims Examiner with over five years of experience reviewing, processing, and adjudicating high-volume Canadian, U.S., and international claims. Proficient in ICD and CPT coding, coverage verification, pre-authorizations, and appeals management. Strong knowledge of medical terminology, insurance regulations, and claims auditing, with a proven ability to identify discrepancies, improve accuracy, and ensure timely claim resolution. Internationally trained dentist with a solid foundation in healthcare administration and compliance.
Overview
7
7
years of professional experience
Work History
Polysomnographic Technologist
MedSleep Clinic
Kingston, Canada
07.2024 - Current
- Conduct patient-facing clinical procedures with meticulous documentation in EMR.
- Communicate test results and procedures with empathy, ensuring patient understanding and satisfaction.
- Collaborate with physicians and administrative staff to coordinate accurate billing and reporting.
Clinic Care Coordinator
Novo HealthNet
Perth, Canada
03.2024 - 05.2024
- Processed insurance claims, verified patient eligibility, and liaised with insurers for approvals.
- Coordinated patient care plans and ensured timely follow-up appointments.
- Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
Medical Billing Specialist
Little Champs Therapy & Yoga
Remote, USA
11.2023 - 02.2024
- Verified insurance coverage, reconciled patient accounts, and handled denials and appeals.
- Coordinated with insurance companies to expedite claim processing and reduce turnaround times.
- Adhered to HIPAA regulations when handling confidential patient information.
Senior Medical Claims Adjudicator
Family Health Plan Insurance TPA
India, India
08.2020 - 01.2022
- Reviewed and adjudicated over 60 daily medical, dental, and pharmacy cases.
- Conducted audits, identified patterns/issues in claims, and suggested process improvements.
- Prepared claims, facts, documents, and trained junior adjudicators.
Claims Examiner
Vidal Health Insurance TPA
India, India
05.2019 - 05.2020
- Processed international medical, dental, and travel claims, ensuring compliance with policy terms.
- Collaborated with providers, labs, and agents to secure documentation for adjudication.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
General Dentist & Clinic Manager
Carewell Multispeciality Dental Clinic
India, India
06.2018 - 04.2019
- Delivered patient care, managed clinic operations, and ensured compliance with regulatory standards.
- Diagnosed dental conditions using comprehensive patient assessments.
- Performed a variety of dental procedures, including fillings and extractions.
Education
Post Graduate Diploma - Healthcare Administration
St. Lawrence College
Kingston, ON, Canada04.2023
Bachelor of Dental Surgery -
SRM Dental College & Hospitals
Chennai, India05.2017
Skills
- Claims processing and adjudication
- Health and dental benefits
- Policy interpretation
- Stakeholder communication
- Data analysis and reporting
- ICD-10 and CPT coding
- Medical terminology
- Process documentation
- MS Office Suite (Excel, Word, Outlook)
- EMR and billing systems (Practice Perfect, Clinic EMRs)
- Claims documentation
- EOB review
- Appeals and denial management
- sleep study analysis
Timeline
Polysomnographic Technologist
MedSleep Clinic
07.2024 - Current
Clinic Care Coordinator
Novo HealthNet
03.2024 - 05.2024
Medical Billing Specialist
Little Champs Therapy & Yoga
11.2023 - 02.2024
Senior Medical Claims Adjudicator
Family Health Plan Insurance TPA
08.2020 - 01.2022
Claims Examiner
Vidal Health Insurance TPA
05.2019 - 05.2020
General Dentist & Clinic Manager
Carewell Multispeciality Dental Clinic
06.2018 - 04.2019
Post Graduate Diploma - Healthcare Administration
St. Lawrence College
Bachelor of Dental Surgery -
SRM Dental College & Hospitals
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