Supervisor Insurance & Revenue
Al Ain Fertility Center
Total des années d'expérience :14 years, 6 Mois
• Developing and maintaining good working relationships with clients and insurance Companies.
• Evaluate medical necessity and consistency of diagnosis, procedure and drug codes and descriptions stated on the claims according to accepted medical coding rules and guidelines while processing claims according to expected daily target, quality, and other key performance indicators (KPIs).
• Minimize risk of financial loss.
• Assist in claims management.
• Preside over claims investigations.
• Maintaining detailed knowledge of new and existing products by liaising with colleagues;
• Assists and monitors in the quality assurance of the insurance.
• Negotiate with Insurance Companies regarding the price and factor rate.
• Train my colleagues regarding Insurance, Coding and the importance of Medical Documentation.
• Protecting the Patient’s privacy and confidentiality of each medical Record.
• Assigning ICD & CPT for the entire encounter as per International Standards &Regulations.
• Assigning E&M codes for all the Consultation.
• Detect the Document deficiency that may causes rejections.
• Supporting the doctors for improving their documentation as per E&M guidelines.
• Medical Records Auditing.
• Assure the assignment of complete, accurate, timely and consistent codes.
• Provide coding and documentation advice to the Medical Team.
• Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse.
• Updating all the Clinical and professional standards as per the HAAD guidelines.
• Follow hospital coding guidelines and regulatory rules in governing corresponding coding decisions.
• All the works assigned by finance manager and Higher Management.
• Assigning E&M codes for all the OP Consultation, DRG for IP visits.
• Helping Insurance team for Resubmission.
• To code and index disease and procedures, surgical operation, and therapeutic procedures according to International Classification of Disease and procedures 9CM (WHO) and Current procedural Terminology (AMA).
• Conducting Qualitative and quantitative analysis regarding ICD-9-CM and/or CPT- 4 code(s) in patient medical record as per simple random sampling methods.
• Assure the assignment of complete, accurate, timely and consistent codes.
• Reconcile clinical notes, patient encounter form, and health information for compliance with HAAD (Health Authority Abu Dhabi) standards.
• Helping Insurance team for Reconciliation.
• Provide coding and documentation advice to the Doctors, insurance people, clinical and professional staff.
• Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse.
• Conducting Qualitative and Quantitative auditing regarding the medical documentation and submitting the auditing reports to the concerned authority and the management people.
• Assure the assignment of complete, accurate, timely and consistent codes.
• Reconcile clinical notes, patient encounter form, and health information for compliance with HAAD (Health Authority Abu Dhabi) standards.
• Helping Insurance team for Reconciliation.
• Provide coding and documentation advice to the Doctors, insurance people, clinical and professional staff.
• Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse.
• Conducting Qualitative and Quantitative auditing regarding the medical documentation and submitting the auditing reports to the concerned authority and the management people.
• Updating all the Clinical and professional standards as per the HAAD guidelines.
• Follow hospital coding guidelines and regulatory rules in governing corresponding coding decisions.
• Support the clinical staff for all documentation purposes.