RCM Executive – UAEN
About the job
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. Page 3 of 6 Controlled Document ADM-HRF-24-R01 • 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/ CP 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 of 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 lP E-claim Submission/IP & OP Resubmission/Reconciliation
Responsibilities
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. Page 3 of 6 Controlled Document ADM-HRF-24-R01 • 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/ CP 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 of 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 lP E-claim Submission/IP & OP Resubmission/Reconciliation
Qualifications
High School, Diploma, Bachelor
