Job Summary
Auditing all Insurance patient claims for appropriate diagnosis and procedure billed and medically justified.
Major Duties and Responsibilities
- Analyzes medical records and identifies documentation deficiencies.
Reviews and verifies documentation supports diagnoses, procedures and treatment results.
- Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
- Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
- Identifies reportable elements, complications in coding process and brings it to the attention of the management.
- Follows all department polices and procedures.
- Participates in on-going education program developed by the department, e.g. Department Policy and Procedures, Fire Safety, Risk Management, Environmental control.
- Preforms any other duties within the range of his/her competence.
- Performs additional tasks and duties as assigned by superiors.
Reporting to
Head of Department
Qualifications:
Education:
- Bachelor Degree with Medical Background.
- Certified Professional Coder (CPC).
Experience:
A minimum of:
Three years experience in related field.
Good experience in a similar position especially in Medical coding.
Competencies & skills:
- Fluency in verbal and written English.
- Must possess complete familiarity with required medical record documentation, Medical Terminology, Anatomy, Physiology, Pathology and Health care statistics.
- Competent knowledge and understanding of current coding guidelines and principles.
- Ability to understand diverse documentation style and read various diagnostic reports contained in the Medical Record.
- Ability to operate computerized patient information system and the personal computer.
Exhibits professionalism and excellent interpersonal communication skills.
