Roles & 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-daybasis.
• •Analysis of the UCF documentation issue from time to time and providing reportsabout 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 claimSubmission, 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 documentationand the coded, diagnosis and selected CPT codes.
• •Senior Coder required to overview the notes prepared for UCF / DischargeSummary have all the required information. In case any information is missingthey 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 rejectionsand reasons for the rejections and how to avoid such rejections.
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• •Verifies the ICD10 CM codes and relevant CPT/HCPCS codes on the claims forsubmission 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 / nurseswith 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 otherday 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

Desired Candidate Profile

• 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.

Employment Type

• Full-time

Company Industry

• MedicalHealthcareDiagnosticsMedical Devices

Department / Functional Area

• DoctorNurseParamedicsHospital TechniciansMedical Research