Marie Mayrose Batiancila-Curob

Duties & Responsibilities:
Providing medical justification for the resubmission of rejected claims.
Ensures accuracy of coded diagnosis, procedures & completeness of supporting documentation.
Ensures diagnosis and procedure codes are supported by appropriate clinical documentation and in coordination with the Coders for accurate data collection and reimbursement.
Reviews patient file for resubmission and follow ups for the incomplete or missing documentation and coordinates with the appropriate clinical or medical staff to ensure the documentation is completed properly.
Recognizes and resolves billing or coding inconsistencies. Uses clinical and coding knowledge to ensure accuracy.
Ensures the appropriate coding of the primary & secondary diagnosis basing on the patient's file.
Analysis of patient's medical data for completeness, accuracy to provide correct justification for the Insurance company.
Updates knowledge using internet, reading articles, medical books and drug handbooks to enhance self and be more effective in resubmission process.
Maintains an average productivity rate of 50 to 100 rejected claims per day (case to case basis and ensures quality of each claims.
Assists with preparation for the clinical documentation monitoring.
Monitor and review related system reports for accuracy and completeness.
Coordinates with Patient Billing in the appeals for the claims denial process as it relates to the Clinical Coding Section.
Coordinates with Physicians, other medical & clinical staff for clinical documentation for more effective function in the patient's medical record.
Participates in internal education programs for physicians and key healthcare providers regarding regulatory requirements and guidelines for clinical documentation.
Identifying trends or problem carriers, and identify areas of concern and present ideas to correct or prevent future issues regarding the rejection of claims.
Monitoring and ensuring that services availed by the patient are billed to the insurance companies on monthly basis.
Analyzes and reconciles accounts, including follow up with payers
Periodical outstanding statements sending to insurance companies for the payment follow up.
Preparing and updating statement of account.
Resolving billing discrepancies with Insurance companies.
Matching of bills (i.e., cheque received from the Insurance companies tally the bill wise amount settled, pending claims take up with Insurance companies).
Ensures and Maintains confidentiality of patient’s protected health information in both electronic and paper formats.
Performed related duties as assigned.

Duties & Responsibilities:
Data entry for Hospital Claims (Paper claims).
Ensures correct, organize and accurate data entries.
Data processing of Medical Claims (E-claims).
Examine, analize and ensure correct calculation of charges in the bill.
Develop and maintain current in filling system.
Encodes hospital billing paper claims and E-claims.
Checks and approves if diagnosis corresponds with the laboratory and medicines requested by the attending physician.
Performed related duties as assigned.

Duties and Responsibilities:

1) Conducts an individualized patient assessment, prioritizing the data, collection based on the adult or elderly patient’s immediate condition or needs within time frame specified by client facility’s policies, procedures or protocols and reprioritizes care accordingly.
2) Conducts ongoing assessments as determined by the adult or elderly patient reflecting collaboration with other members of the health care team.
3) Develops plan of care that is individualized for the adult or elderly patient reflecting collaboration with other members of the health care team.
4) Performs appropriate treatments as ordered by physician in an accurate and timely manner.
5) Performs therapeutic nursing interventions as established by individualized plan of care for adult or elderly patient and his/her family.
6) Provides individualized patient/family education customized to the adult or elderly patient and his/her family
7) Document patient assessment findings, physical/psychosocial responses to nursing intervention and progress towards problem resolution.
8) Initiates emergency resuscitative measures according to adult resuscitation protocols.
9) Maintains confidentiality in matters related to patient, family and client facility staff.
10) Provides care in a non-judgmental, non-discriminatory manner.