Job title: QA Associate – Coding (OP)
Job description: Role Summary:
To audit claims coded by coders, do TNA and provide efficient training and bridge the knowledge gap in coders.
- Ensure that the medical ethics are respected at all times while performing the medical evaluation of the claims.
- Responsible for retrospective and concurrent reviews on coding staff.
- Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed.
- Review provider’s specifications and highlight inconsistencies or lack of information. Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.
- Conduct training to improve the technical, insurance and medical skills and knowledge for team members as assigned by the QA lead.
- Participate and Contribute during biweekly calibration on error grading standards to help build a robust Quality Program along with QA lead.
- Provide all the needed support as advised by the supervisor/Manager based on the business need.
- Responsible of successful Rampup plan of new coders.
- Ensure the audit tracker is updated and the data provided is accurate.
- Suggestions to create audit tools and strategies to improve the audit process
- Other related tasks assigned by the line manager
- Bachelor’s Degree in the medical field or science background
- Coding certification from AAPC or AHIMA is must.
- Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, HCPCS codes, Current Procedural Terminology (CPT), modifiers.
- Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology.)
- At least 2-3 years medical claims auditing experience.
- Having UAE experience is an added advantage.
- Good knowledge of insurance protocols.
- Should have good IT skills.
Job date: Sat, 23 Jul 2022 22:13:12 GMT
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