OP Medical Coder

• 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 claiming

  payments 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

Desired Candidate Profile

• 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.