Senior Officer - RCM

Job Description

• Claims Auditing and Analysis:
  • Audit outpatient claims to ensure accuracy in coding, billing, and documentation.
  • Review denied claims to identify root causes and trends (e.g., coding errors, eligibility, medical necessity).
  • Perform audits on processed claims to confirm compliance with DOH, DHA, and MOH guidelines.
  • Ensure proper application of CPT, ICD-10-CM, HCPCS, and other coding standards.
• Denial Analysis and Management:
  • Analyse denial trends and patterns to identify areas for improvement.
  • Collaborate with the coding and resubmission teams to address common denial reasons.
  • Develop and implement strategies for resubmission of denied claims, ensuring maximum reimbursement.
• Coding and Documentation Support
  • Verify the accuracy and completeness of coding (CPT, ICD-10, HCPCS) used in outpatient claims.
  • Provide recommendations and corrections to improve documentation for accurate billing.
  • Work with clinicians and administrative teams to ensure proper documentation practices.
• Training and Process Improvement:
  • Conduct training sessions for teams on claim submission, denial handling, and coding updates.