UNIT TITLE : MANAGE MEDICAL CLAIMS UNIT CODE : ICT325303 UNIT DESCRIPTOR : This unit covers the skills, knowledge and attitude necessary to manage medical claims. It covers managing account receivable, denials/ rejections and underpaid medical claims. ELEMENT PERFORMANCE CRITERIA REQUIRED KNOWLEDGE REQUIRED SKILLS Italicized terms are elaborated in the Range of Variables Manage Processed and Medical Terminology Analytical skills account submitted claims are Systems of the Reading and body (e.g., skeletal, receivable tracked and monitored comprehension respiratory, based on enterprise or skills cardiovascular) client requirements Researching Human anatomy Pending claims are skills Human physiology followed-up from payer Basic Fundamental and/or patient in mathematical nature of a disease accordance with skills process, signs, enterprise policy Communication symptoms and Supporting documents skills methods of are Identified and Computer skills treatment requested from the Common medical medical provider based conditions on payer requirements Medical (when necessary) investigations and Posting of payments procedures are performed in Injuries accordance with Common enterprise/client’s policy abbreviations for medical and pharmacological terms (e.g., BCG, HRT) Common medications Commonly used medical equipment and instruments Laboratory testing methods Diagnostic and surgical procedures Laboratory values and significance Medico-legal terminology Medical Documentation Medical claim process
UNIT TITLE : MANAGE MEDICAL CLAIMS UNIT CODE : ICT325303 UNIT DESCRIPTOR : This unit covers the skills, knowledge and attitude necessary to manage medical claims. It covers managing account receivable, denials/ rejections and underpaid medical claims. ELEMENT PERFORMANCE CRITERIA Italicized terms are elaborated in the Range of Variables REQUIRED KNOWLEDGE REQUIRED SKILLS Manage account receivable Processed and submitted claims are tracked and monitored based on enterprise or client requirements Pending claims are followed-up from payer and/or patient in accordance with enterprise policy Supporting documents are Identified and requested from the medical provider based on payer requirements (when necessary) Posting of payments are performed in accordance with enterprise/client’s policy Medical Terminology Systems of the body (e.g., skeletal, respiratory, cardiovascular) Human anatomy Human physiology Fundamental nature of a disease process, signs, symptoms and methods of treatment Common medical conditions Medical investigations and procedures Injuries Common abbreviations for medical and pharmacological terms (e.g., BCG, HRT) Common medications Commonly used medical equipment and instruments Laboratory testing methods Diagnostic and surgical procedures Laboratory values and significance Medico-legal terminology Medical Documentation Medical claim process Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills