Rcm Administrator

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.
- 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.
- Responsible for lP E-claim Submission/IP & OP Resubmission/Reconciliation
- Manages Claims Submission by checking accuracy of CPT and ICD coded invoices. Rectifies errors in billing in coordination with the doctors.
- Bachelor's degree from an accredited college / university.
- Certification from AAPC / AHIMA is a must.
- Minimum 2 years’ experience in a similar environment and similar role.
- Proficient in ICD 10, CPT 4 coding conventions. Knowledge of relevant software system such as MS Office, particularly Excel.
- Good Experience in Coding of Inpatient and Outpatient claims for Billing & Reimbursement purposes.
- Communication skills
- Ability to work independently Information processing ability
- Accuracy and Attention to detail