Submission and Resubmission Medical Coder

Position Summary

We are seeking an experienced submission, resubmission Medical Coder with a strong background in hospital coding to join our healthcare team. The ideal candidate will be responsible for translating healthcare services and procedures into standardized codes for billing and reimbursement purposes. This role demands a detail-oriented individual with a deep understanding of ICD-10-CM, CPT, HCPCS , IP, OP  coding systems, and hospital-specific coding practices.

Summary of Main Duties

•    To code final diagnosis and procedures using ICD-10-CM and CPT-4,HCPCS,DSL, DRG, IP, OP 
•    Validate the ICD codes with CPT codes and identify the not covered cases, if any.
•    Identify the not covered cases, if any.
•    Analyze Medical Documentation deficiencies. 
•    Assist/educate/train the health professionals for appropriate documentation and frequently liaison with them.
•    Inform billing team of any cancelation of charges to enable them to issue refund, if any.
•    Investigates and evaluates potential causes for changes or problems; takes appropriate steps in collaboration with the right staff to effect resolution or explain variances
•    Meeting claim submission deadlines with high level accuracy
•    Maintain the understanding of anatomy, physiology, medical terminology, disease process and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM, CPT-4, HCPCS and DSL.
•    Adhere to DHA policies and AMA guidelines
•    Maintains knowledge of current and required coding certifications as appropriate; may perform the most technical complex and difficult coding and abstraction work
•    Adhere to confidentiality policy
•    Communicate with payers and liaise with internal departments 
•    Be part of Resubmission team in resubmitting the claims rejected for medical reason and with the Submission team in submitting claims as per general compliance and coding guidelines (as may be assigned from time to time.
•    Analyzing the denied claim and making sure that it is resubmitted accurately as per denial reason, ensuring that diagnosis and CPT codes are updated wherever necessary. 
•    Reviewing the RAs (remittance advices) from insurance companies and update for the potential resubmission claims and identify the critical area for improvement. 
•    Review reconciliation claims from medical and Technical point of view and making sure that proper medical justification is given as per denial reason and ensuring that all technical requirements are met. 
•    Publish or generate timely internal reports to line manager and HOD 
•    Interacting with the physicians and other patient care providers regarding billing ,coding and documentation policies, procedures, and regulations; obtaining clarification of conflicting, ambiguous, or non-specific documentation 
•    Identify Discrepancies, billing issues, coding, medical documentation and different plans errors and report the errors and correction.
•    Be actively involved in the quality improvement activities within the Department
•    Performs other related duties as assigned
 

Position Requirements/Qualifications

• Experience with hospital coding software systems (e.g., Epic, Cerner).
• Knowledge of the 5010 electronic data interchange (EDI) standards.
• Strong communication skills for collaborating with healthcare providers and the billing team.
• Knowledge of compliance regulations such as HIPAA and Medicare/Medicaid billing requirements.
• Familiarity with revenue cycle management (RCM).