Medical Insurance Claim specialist
NMC Hospital
مجموع سنوات الخبرة :7 years, 1 أشهر
• Responsible for submission and resubmission of all medical claims in the hospital.
• Auditing and verifying of insurance claims of IP & OP claims and denial management.
• Supervising resubmission of claims by adding medical terms to get the approval.
• Assigning medical codes using ICD 9, ICD 10, CPT, and HCPCS codes.
• Ensuring accurate coding and sequencing diagnosis and procedure codes as specified by established coding principles and government guidelines.
• Reviewing and analyzing patient medical records to ensure all applicable patient data is available for coding and abstracting required information from patient records and assigning the relevant codes.
• Coordinating with physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes
• Assists Team Leader in creating reports on unbilled/ denial records due to documentation/ coding, charge errors, and registration errors.
• Providing medical records for preparation of medical audit report and quality assurance by providing the coding details.
• Operates data base and medical billing and coding software like HIS and eClaim
• Tracks complaints and incidents occurring within the coding system and report to Team Leader.
• Reviewing & analyzing of denial claims and finding reasons for denial.
• Ensure claims are entered and submitted on time and prepare report to management.
• Arranging clinical coding training for Hospital staff including doctors and supporting staff.
• Contacting clinic or other departments/ sections for collecting additional information to complete coding purposes.
• Attending seminars, workshops and publications to update the latest changes in insurance industry and coding rules.