RCM Administrator

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.

Qualifications

• 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