Summary
Overview
Work History
Education
Skills
Timeline
Generic

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, Canada
04.2023

Bachelor of Dental Surgery -

SRM Dental College & Hospitals
Chennai, India
05.2017

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
Resbin Mohammed