RCM Officer

Job Description

• Review Documentation: Coder is responsible for reviewing physician documentation in the UCF/E-Discharge summary to identify discrepancies between the documentation, coded diagnoses, and selected CPT codes.

• Senior Coder Oversight: Senior Coder ensures that the UCF/Discharge Summary notes contain all required information. If any information is missing, they are responsible for contacting the physician to complete it.

• Clarification Support: Be available to consultants for clarification regarding ICD/CPT codes.

• Rejection Management: Senior Coder engages with clinicians to discuss specialty-specific rejections, the reasons for these rejections, and strategies to avoid them in the future.

• Verification of Codes: Verify ICD-10 CM codes and relevant CPT/HCPCS codes on claims for submission to insurance companies on a daily basis.

• Reports and Feedback: Provide reports and feedback on the proper implementation of ICD/CPT coding practices. Develop training materials and support cashiers, claims processors, and nurses regarding ICD/CPT and other relevant medical coding requirements.

• Identifying Non-billable Codes: Identify ICD codes (Diagnosis under Exclusion) and CPT codes (non-billable). Ensure e-claims are uploaded to DHPO and other necessary portals for direct billing claim payments.

• Insurance Coordination: Coordinate with insurance company medical teams for clarifications and resolve day-to-day issues.

• Billing Coordination: Work with Billing Supervisors and Accountants for e-claim submissions, resubmissions, follow-ups, reconciliations, and final sign-offs.

• Software Entry: Enter codes into the software application while adhering to company policies and procedures.

• E-claim Responsibilities: Responsible for IP E-claim submission, IP & OP resubmission, and reconciliation.