Responsibilities Specialist in Emergency Department (E&M) by evaluating the Physicians documents and services provided to the patients. Giving accurate E/M levels and ED Levels as per the documentation both in Facility and Professional coding. Perform Hospital Outpatient Coding and code medical records with ICD-9, CPT-4, and HCPCS, coding and achieving productivity goals. Duties also include handling wide variety of medical claims including Outpatient Consultation, Radiology and Surgery. Coding & Auditing OP medical records & consultation reports using proper E/M codes based on 1995 guidelines and using Encoder Pro for ICD-9CM codes.

Responsibilities Coding & Auditing Outpatient medical records & consultation reports using proper E/M codes based on 1997 guidelines and using 3M for diagnosis coding. Production: Dealing with timely production of Outpatient claims by performing in different specialities like ER and E&M, Surgery like Gastroenterology, ENT, Ophthalmology, Cardiology, Urology & Diagnostic testing etc. Abstract all necessary information from health records to identify secondary complications and co- morbid conditions. Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse. Analyse Documents to improve coding data accuracy for reimbursement. Provide coding and documentation advice to the Physicians, coding unit, clinical and professional staff to increase the revenue to the hospital. Re submission: Review the rejected claims from the insurances & resubmit the claims with appropriate medical justification as per HAAD & insurance guidelines as well. Pre-approval: Coding Pre approval request for claims like Day case, DRG case, Outpatient procedures like (MRI, CT, Radiology etc.) & validating and submitting it to the insurance company.

Responsibilities Lead and manage the RCM team, providing guidance and training to ensure effective RCM program implementation. Develop and implement strategies to optimize the revenue cycle process, including patient registration, coding, charge capture, billing, collections, and denial management. Develop and maintain strong relationships with payers, resolving billing discrepancies, negotiating contracts, and staying updated on reimbursement policies and changes. Conduct regular audits of billing and coding practices to ensure compliance with regulatory guidelines and payer requirements. Analyze denial trends and implement strategies to minimize denials, improve claims accuracy, and maximize revenue realization. Provide regular reports to management on revenue cycle performance, financial metrics, and opportunities for improvement. Collaborate with cross-functional teams, such as coding, billing, and clinical departments, to streamline processes, resolve issues, and improve revenue cycle efficiency. Develop and implement comprehensive RCM strategies, maintenance plans, and procedures across the organization. Stay abreast of industry trends, best practices, and regulatory changes related to revenue cycle management, and proactively implement necessary updates to processes and systems.