Medical Coder /Claims Audit
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Key skills for this role
About the Role
We are looking for Medical Coder /Claims Audit who is highly proficient in computer software and Microsoft applications, holding license/certification in AAPC/AHIMA with wide knowledge and understanding in HAAD / DHA / IA guidelines, rules & standards.
Key Skills for This Role
Full Job Posting
Overview
We are looking for **Medical Coder /Claims Audit** who is highly proficient in computer software and Microsoft applications, holding license/certification in AAPC/AHIMA with wide knowledge and understanding in HAAD / DHA / IA guidelines, rules & standards.
Educational Qualification
- Graduate in Nursing/ MBBS/BAMS /BHMS + license/certification in AAPC/AHIMA
Additional Requirements
- Minimum 3 - 5 years’ experience in medical coding or pre-approval department in a health care (TPA /Insurance) industry
- The candidate should have adequate knowledge about regulatory guidelines
- Knowledge in DRG guidelines
- Knowledge and practical experience in Provider –Audit will be an added advantage
Job Expertise
- Ensure the claims audit and recovery process are in compliance with PD 01/2019 &HAAD/SD/HSFR/0.9 and adherence to timelines mentioned in the circular.
- Lead the provider audit team, conduct the onsite/offsite audit, and prepare audit findings report, communications with provider, and documentation and closure actions as per authority requirement.
- Maintain the provider audit/recon communication documentations as per authority requirement.
- To coordinate with Claims, Network and Finance team for recovery payment related communications and collection for the same.
- Identifies discrepancies, potential quality of care, billing issues and analyzes, recommends and facilitates plan of action to correct discrepancies and prevent future coding errors.
Remuneration
- At par with best in industry
- No. of Vacancy:
- 02 Nos
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