Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems include but not limited to: Diagnosis code set Procedure code set Supplies Code set Client-specific guidelines and coding and claims processing standards 5S and 3Rs Manage Denied/ Rejected Medical Analytical skills denied/ claims are reviewed Terminologies Reading and rejected based on the explanation Medical comprehension claims of benefits from the Documentation skills insurance company. Medical claim Researching Reasons for process skills denial/rejections are Healthcare Laws Basic verified with payer’s and Ethics mathematical adjusters in line with Essential of skills enterprise policy. healthcare insurance Communication Necessary adjustments Medical Coding skills are made on the Systems Computer skills explanation of benefits Diagnosis Code set Procedure Code set from the insurance Supplies Code set company. Supporting documents are Identified and requested from the medical provider based on the payer requirements. Adjusted claims are in compliance Client’s specific with payer’s guidelines / Coding requirements and claims standards 5S and 3Rs Manage Underpaid claims are Medical Analytical skills underpaid reviewed based on the Terminologies Reading and claims explanation of benefits Medical comprehension from the insurance Documentation skills company. Medical claim Researching process skills
Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems include but not limited to: Diagnosis code set Procedure code set Supplies Code set Client-specific guidelines and coding and claims processing standards 5S and 3Rs Manage denied/ rejected claims Denied/ Rejected claims are reviewed based on the explanation of benefits from the insurance company. Reasons for denial/rejections are verified with payer’s adjusters in line with enterprise policy. Necessary adjustments are made on the explanation of benefits from the insurance company. Supporting documents are Identified and requested from the medical provider based on the payer requirements. Adjusted claims are in compliance with payer’s requirements Medical Terminologies Medical Documentation Medical claim process Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems Diagnosis Code set Procedure Code set Supplies Code set Client’s specific guidelines / Coding and claims standards 5S and 3Rs Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills Manage underpaid claims Underpaid claims are reviewed based on the explanation of benefits from the insurance company. Medical Terminologies Medical Documentation Medical claim process Analytical skills Reading and comprehension skills Researching skills