Coder-inpatient Biller

**Description**: The Inpatient Biller is responsible for timely submission of claims to insurance companies for Inpatient, Outpatient and Day case claims.****

**Job Functions and Key Accountabilities**:

Adhere to the DOH Claims and Adjudication rules and payer guidelines

Acts as a resource when necessary for pre-authorization.

Excellent interpersonal skills while interacting with physicians, nurses and other staffs.

Be a mentor for the team members and work with team to ensure high level of accuracy.

Ensure high level of patient data confidentiality.

Knowledge on Diagnosis related grouping

Knowledge in Schema validation rules.

Utilizes tools available in 3M to ensure accurate coding.

Ensure knowledge on deductibles, co-payments, co-insurance amounts, insurance exclusions and other policies of all insurances that Kanad Hospital is dealing with.

Critical thinker with ability to perform root cause analysis, prepare and implement action plans and lead improvement initiative.

Perform other related duties incidental to the work described herein.

**Technical Competencies**:

Reviews patient bills for accuracy and completeness; obtains missing information and creates invoices for submission and resolves billing issues as they arise.

Expert in identifying potential errors that may lead to denial and ensures timely submission of all the claims by following the 24 hour rule.

Ensure that every claim has a valid approval whenever required and patient share has been reflected in the claim appropriately.

Validating the scrubber xml and communicating the errors to the coder as they arise before the claim submission and making sure that the changes have been reflected in the claim.

Consistently maintain quality and productivity standards and achieve the productivity target with desired quality of >/95%.

**Qualification**:** Education**: Degree in any related field preferably life science background. CPC (AAPC) certification will be a plus.
**Experience**:** Experience**: Minimum of three (3) years Inpatient coding experience in any setting i.e., hospital, clinic, or other related healthcare field is required. In addition to medical coding, knowledge of billing process will be a plus. Both inpatient and outpatient experience preferred.