RCM Executive – UAEN
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
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