Rahana Shamsudeen

Evaluates and processes inpatient insurance approvals for admissions, surgeries, and extended stays by reviewing medical necessity and submitting prior authorization requests. Conducts final approval decisions and manages revisions, appeals, and denial/escalation workflows in line with UAE insurance guidelines and hospital protocols.

Handles pre-approvals and insurance coordination for day care, outpatient, and dental procedures, ensuring eligibility, approvals, reconciliation, and payment alignment. Manages claims filing and tracking, supports physicians with coding guideline education, and resolves billing/insurance issues while maintaining medical record confidentiality.

Assigns accurate dental procedure codes and supports the full pre-authorization and insurance workflow for routine and major dental treatments. Reviews patient records for coding discrepancies, coordinates documentation with dentists, and helps resolve billing and insurance issues while handling benefit inquiries.

Performs medical coding and billing for hospitals and clinics using ICD-10-CM, CPT, and HCPCS, ensuring compliant and timely E-claims submissions. Conducts coding audits and collaborates with healthcare providers to resolve coding discrepancies and improve documentation quality for accurate reimbursement.

Completed a medical coding and billing license program and became a Certified Professional Coder (CPC) with Member ID 01698386.

Earned a Bachelor of Science degree in Botany from the University of Calicut from 2015 to 2018.