RCM Administrator

Job Description

Job Description

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

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-day basis.
• Analyze the UCF documentation issue from time to time and provide 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 supervisors/ 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

 

Qualifications

• 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.