RCM Administrator - UAE National NMC healthcare LLC

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.