RCM Executive – UAEN

September 28, 2024

Job Description

Claims Processing Team: Submission 

  • Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
  • Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
  • Uploads OP E-claims
  • Identifies commonly used ICD codes and relevant CPT codes and compile the list.
  • Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
  • Reports variations / irrelevance in the CPT codes used for services/procedures.
  • Assigns proper CPT/ HCPCS codes for newly added services / procedures.
  • Reports the audit findings about discrepancies in the claims daily.
  • Be available to the Consultants about clarification regarding the ICD/ CPT codes.
  • Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off. Claims Processing Team: Resubmission
  • Coder is required to review documentation by the physicians in the UCF / E – Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
  • Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
  • Be available to the Consultants about any clarification regarding ICD/CPT codes.
  • Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections

Qualifications

High School, Diploma, Bachelor