وصف الوظيفة
Role Overview
IP Medical Coder at NMC Healthcare. The role is part of the Claims Processing Team, responsible for coding verification, claims submission and resubmission, and coordination with internal and external stakeholders.
Role Purpose
Verify and assign appropriate ICD-10 CM, CPT, and HCPCS codes for inpatient and outpatient claims; ensure accurate documentation and coding compliance; coordinate claims submission and resubmission with insurance companies, billing teams, and clinical staff; and support organizational coding standards and training.
Key Responsibilities
Claims Submission
- Verify ICD-10 CM codes and relevant CPT/HCPCS codes on the UCF or discharge summary for submission to various insurance companies on a daily basis.
- Upload OP (outpatient) e-claims.
- Identify commonly used ICD codes and relevant CPT codes and compile the list.
- Identify ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
- Report variations or irrelevance in CPT codes used for services and procedures.
- Assign proper CPT/HCPCS codes for newly added services and procedures.
- Report audit findings about discrepancies in claims daily.
- Provide clarification to Consultants regarding ICD/CPT codes as needed.
- Coordinate with Insurance Doctors and Billing Supervisor/Accountants for e-claim submission, resubmission, follow up, and final sign off.
Claims Resubmission and Analysis
- Review physician documentation in the UCF or e-discharge summary and identify discrepancies between documentation, coded diagnosis, and selected CPT codes.
- Overview notes prepared for UCF or discharge summary to ensure all required information is present; contact physicians to fill in missing information as needed.
- Provide clarification to Consultants regarding ICD/CPT codes as needed.
- Speak to clinicians about specialty-specific rejections, reasons for rejections, and strategies to avoid such rejections.
- Provide reports and feedback about proper implementation of ICD/CPT coding.
- Analyze UCF documentation issues and provide reports about areas of concern in coding and claims.
- Upload e-claims to the DHPO and/or other portals necessary for claiming payments of direct billing claims.
- Coordinate with Insurance Companies medical teams for clarifications and day-to-day issues.
- Coordinate with Billing Supervisor/Accountants for e-claim submission, resubmission, follow up, reconciliation, and final sign off.
- Enter codes into the software application.
Training and Support
- Provide training material and support to cashiers, claims processors, and nurses regarding ICD/CPT and other relevant medical coding requirements.
Compliance
- Adhere to the company's policies and procedures.
- Own IP e-claim submission, IP and OP resubmission, and reconciliation responsibilities.
Qualifications & Experience
- Bachelor's degree from an accredited college or university.
- Bachelor's degree in nursing, pharmacy, or physiotherapy preferred.
- Certification from AAPC or AHIMA is mandatory.
Skills & Competencies
- Expertise in ICD-10 CM, CPT, and HCPCS coding systems.
- Proficiency with software applications for code entry and claims processing.
- Knowledge of UCF (Unified Coding Format) and discharge summary documentation standards.
- Knowledge of DHPO and insurance company portal systems.
- Ability to identify coding discrepancies and audit findings.
- Communication and clarification skills for working with clinicians, consultants, and billing teams.
- Attention to detail and accuracy in code verification and assignment.
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