Client’s specific guidelines/ coding and claims processing standards 5S and 3Rs Screen claims Claims are checked for Medical Terminologies Analytical skills authorization, eligibility Medical Documentation Reading and based on provider and/or Medical claim process comprehension subscriber contract with Healthcare Laws and skills the payer Ethics Researching skills Completeness of claims Essential of healthcare documentation are insurance Basic checked in accordance Medical Coding Systems mathematical with payer requirements International skills Lacking data on the Classification of Communication initial screening result are Diseases skills requested from medical Current Procedural Computer skills provider Terminology Healthcare Common Procedure Coding System Client’s specific guidelines/ coding and claims processing standards Process Encode patient, provider Medical Terminologies Analytical skills claims/billing and/or billing Medical Documentation Reading and information Medical claim process comprehension Determine reimbursable Healthcare Laws and skills procedures and/or Ethics Researching skills services based on existing Essential of healthcare insurance contract or insurance Basic provider contract or any Medical Coding Systems mathematical existing reimbursement include but not limited to: skills guidelines Diagnosis Code Set Communication Billing information is Procedure Code Set skills verified for completeness Supplies Code set Computer skills of data based on the Client’s specific required fields. guidelines/ coding and Determine billing address claims processing and facility based on standards insurance contract
Client’s specific guidelines/ coding and claims processing standards 5S and 3Rs Screen claims Claims are checked for authorization, eligibility based on provider and/or subscriber contract with the payer Completeness of claims documentation are checked in accordance with payer requirements Lacking data on the initial screening result are requested from medical provider Medical Terminologies Medical Documentation Medical claim process Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems International Classification of Diseases Current Procedural Terminology Healthcare Common Procedure Coding System Client’s specific guidelines/ coding and claims processing standards Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills Process claims/billing Encode patient, provider and/or billing information Determine reimbursable procedures and/or services based on existing insurance contract or provider contract or any existing reimbursement guidelines Billing information is verified for completeness of data based on the required fields. Determine billing address and facility based on insurance contract Medical Terminologies 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’s specific guidelines/ coding and claims processing standards Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills
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