Duties & Responsibilities :
Performing data entry of client information for billing
Generating, updating, and maintaining patient profiles for both current and new clients
Responsible for the submission of required reports for approval / re-approval while coordinating with supervisors
Demonstrating professional demeanor over the phone and providing customer service while making claim inquiries
Resolving patients’ complaints and concerns
Demonstrating strong attention to details and the ability to multi-task within a fast-paced work environment
Ensuring the completeness of all insurance forms and sub-forms
Providing high quality submissions at all times
Preparing and submitting claims for payment in a timely manner
Responding to inquiries regarding accounts
Posting cash receipts as received, if any
Completing accounts receivable and accounts payable reports
Monitoring accounts receivable and outstanding insurance claims
Maintaining a minimum balance in outstanding accounts
Preparing claims and reports as requested by management and as scheduled
Creating, maintaining, and updating billing manuals with new or changing rules and regulations
Attending provider billing training as needed for updates
Maintaining current expertise in billing and collections
Maintaining confidentiality of client and personnel information
Performing job functions in compliance with regulations and agency policies and standards
Tracking and cross-checking all forms, claimed amounts, level of care, duration of care, etc.
Performing other duties as assigned
Other Duties :
Audits records to ensure proper submission of services prior to billing on pre-determined selected charges
Receives hospital information to properly bill provider services for home care patients
Supplies correct ICD-10-CM 2015 diagnosis codes on all diagnoses provided
Supplies correct HCPCS code on all procedures and services performed
Supplies correct CPT code 2011 on all procedures and services performed
Contacts providers to train and update them with correct coding information
Attends seminars and in-services as required to remain current on coding issues
Audits medical records to ensure proper coding completed and to ensure compliance with regulatory bodies
Accurately follows coding guidelines and legal requirements to ensure compliance with regulatory bodies
Maintains all mandatory in-services
Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct.
Reports compliance problems appropriately.
Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as : patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered.
Reviews the records for compliance with established reimbursement and special screening criteria.
Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.
Medical Bachelor Degree - BS Nursing preferred
Working knowledge of the billing process in a healthcare setting in the Emirate of Abu Dhabi
CPC - Certified Professional Coder or CCSPB-Certified Coder Specialist Physician Based
Minimum of 1 year experience in billing, in a Home Care setting
Must have a TASNEEF, JAWDA & DOH Audit exposure
Not less than two years medical coding experience post qualification in appropriate setting