Auditing:
 Auditing & Reviewing (Focused versus Random Audits, Prospective versus Retrospective Audits, Statistical Sampling) for coded files, DRG levels accuracy and completeness with coded diagnosis & procedures.
 Aggregate Analysis, Scope of the Audit, Determining Which Services to Audit, Determining the Number of Records to Audit, Audit Parameters, Materials and Resources, Documentation Guidelines, Applicable Payer Guidelines, Applicable Office Policies, Pertinent Office Documentations
 Auditing focus on Coding, Billing, Submission and Documentation deficits
 Involving in FWA activities and assisting in developing & maintaining policies and procedures for coding guidelines and concepts
Clinical Documentation improvement CDI:
 Assisting Doctors for Clinical documentation improvement by review documentation to facilitate the accurate representation of the severity of illness, risk of mortality and complexity of procedure.
 Increased the reimbursement on 25% of the charts reviewed, facilitating accurate MD documentation resulting in an IR DRG (MDCs)
 Facilitating improvement in the overall quality Inpatient charts and completeness of medical record documentation through querying physicians concurrently along with formal & informal education, clarification of documentation on diagnoses, POA and Procedures
 Performing concurrent/retrospective reviews of medical records, establish working IR-DRG, evaluating SOI/ROM, support core measures and other quality reporting measures.
IP and OP Coding:
 IR DRG coding in line with DHA guidelines and HAAD adjudication rules
 Coding long term Care- LTC files as per DHA guidelines and HAAD adjudication rules
 Pre-authorization approval coding for IP admission, Day care admission, OP special study investigation according to HAAD guidelines
 Daily Basis Medical Coding on OP claims
 Proficient in ICD-10 and ICD 9 CM, CPT-4, and HCPCS
 Clear understanding of medical terminology.
 Working experience with medical coding software platforms such as 3M-HIS coding & Encoder Pro
 In-depth knowledge of coding guidelines