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.
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

Manages Claims Submission by checking accuracy of CPT and ICD coded invoices. Rectifies errors in billing in coordination with the doctors.

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