Submission & Resubmission Officer

Job Description

Manages Claims Submission by checking accuracy of CPT and ICD coded invoices. Rectifies errors in billing in coordination with the doctors.

Responsibilities

Claims Processing Team: Submission

• Verifies the ICD10 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.
• Verifies the ICD10 CM codes and relevant CPT/HCPCS codes on the claims for submission to various insurance companies on day-to-day basis.
• Provides Reports/feedback about proper implementation of ICD/CPT coding.
• Provides training material and support to the cashiers/claims processors/nurses with regards to ICD/CPT and other relevant medical coding requirements.
• Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
• Uploads e-claims to the DHPO and/or any other portal necessary for claiming payments of direct billing claims.
• Coordinates with Insurance Companies medical teams for clarifications and other day to day issues.
• Coordinates with Billing Supervisor/Accountants for e-claim submission, Resubmission, Follow Up, Reconciliation and Final Sign off.
• Enters the codes in the software application.
• Adheres to the company’s policies and procedures.
• Responsible for IP E-claim Submission / IP & OP Resubmission / Reconciliation.

Qualifications

Bachelor’s degree from an accredited college / university.
Bachelor’s degree in nursing, pharmacy, physiotherapy etc. will be preferred. Certification from AAPC / AHIMA is a must.