UNIT : 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 REQUIRED Italicized terms are elaborated in KNOWLEDGE SKILLS the Range of Variables Manage Processed and submitted Medical Terminology Analytical skills account claims are tracked and Systems of the body Reading and receivable monitored on comprehension (e.g., skeletal, enterprise or client skills respiratory, requirements Researching cardiovascular) Pending claims are skills Human anatomy followed-up from Basic Human physiology and/or patient in mathematical Fundamental nature of a accordance with skills disease process, signs, enterprise policy Communication symptoms and methods Supporting documents skills of treatment are Identified and Computer skills Common medical requested from the conditions medical provider based on Medical investigations payer requirements (when and procedures necessary) Injuries Posting of payments are Common abbreviations performed in accordance for medical and with enterprise/client’s pharmacological terms policy (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 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
UNIT : 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 on enterprise or client requirements Pending claims are followed-up from 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 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 Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills
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