Minimum of one (1) years’ experience with post qualification in related field
Knowledge of Medical Terminologies, Ability to be an effective team member, ability to work with different software technologies and able to manage multi-tasking effectively.
Responsible for medical interpretation, extracting and submission of medical claims services from the company as the Insurance provider from Medical Records.
Review, analyze and abstract clinical information from patient medical records and documents for diagnostic and procedure codes assignment for Home care patients.
Evaluate medical necessity and consistency of diagnosis, procedure and drug codes and descriptions stated on the claims as specified by established coding principles and guidelines.
Perform pre authorization requests, billing, claims submission and re submissions.
Analyze medical claims data to provide proper and accurate feedback to the client on denials and rejections with reasons for such rejection.
Understand with work and mandated code sets such as ICD codes for diagnosis, CPT codes for procedures, IRDRG codes, HCPCS, Drug codes during adjudication and processing.
Coordinate with Case managers, Clinicians, Clinical Manager and Patient Relations Manager for referrals and service approvals accordingly.
Coding Certification from AAPC, Medical Coding Certification (Preferred)
