✨ AI Summary
The OP Medical Coder will be responsible for verifying and assigning ICD-10 CM and CPT/HCPCS codes on UCF/discharge summaries for submission to insurance companies. This role involves analyzing documentation for discrepancies, uploading e-claims, identifying specific ICD and CPT codes, and reporting audit findings. The coder will also provide clarifications to consultants and coordinate with insurance doctors and billing supervisors for claim submission and resubmission processes. Additionally, the role includes providing training materials to cashiers, claims processors, and nurses regarding medical coding requirements and coordinating with insurance company medical teams for clarifications.
laims 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-daybasis.•Analysis of the UCF documentation issue from time to time and providing reportsabout 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).•
Description
laims 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-daybasis.•Analysis of the UCF documentation issue from time to time and providing reportsabout 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 claimSubmission, 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 documentationand the coded, diagnosis and selected CPT codes.•Senior Coder required to overview the notes prepared for UCF / DischargeSummary have all the required information. In case any information is missingthey 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 rejectionsand reasons for the rejections and how to avoid such rejections.Page 3 of 6 Controlled Document ADM-HRF-24-R01•Verifies the ICD10 CM codes and relevant CPT/HCPCS codes on the claims forsubmission 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 / nurseswith 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 claimingpayments of direct billing claims.•Coordinates with Insurance Companies medical teams for clarifications and otherday 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/ReconciliationREPORTING STRUCTURE