Manage Denied/ Rejected claims Analytical skills Medical Terminologies denied/ are reviewed based on the Reading and Medical Documentation rejected explanation of benefits comprehension Medical claim process claims from the insurance skills company. Researching Healthcare Laws and Ethics Reasons for skills Essential of healthcare denial/rejections are Basic insurance verified with payer’s mathematical Medical Coding Systems adjusters in line with skills enterprise policy. Communication Diagnosis Code set Necessary adjustments skills Procedure Code set are made on the Computer skills Supplies Code set explanation of benefits from the insurance company. Supporting documents are Identified and requested from the medical provider on the payer requirements. Adjusted claims are Client’s specific guidelines / in compliance Coding and claims with requirements standards 5S and 3Rs Manage Underpaid claims are Analytical skills Medical Terminologies underpaid reviewed based on the Reading and Medical Documentation claims explanation of benefits comprehension Medical claim process from the insurance skills company. Researching Healthcare Laws and Ethics Reasons for skills Essential of healthcare underpayment are Basic insurance verified with mathematical Medical Coding Systems adjusters in line with skills enterprise policy. Communication Diagnosis Code set Supporting documents are skills Procedure Code Set prepared based on payer Computer skills Supplies Code set requirements. Client’s specific guidelines / Underpaid claims are Coding and Claims together with Standards appeal request in line with 5S and 3Rs enterprise/client’s policy.
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 on the payer requirements. Adjusted claims are in compliance with 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. Reasons for underpayment are verified with adjusters in line with enterprise policy. Supporting documents are prepared based on payer requirements. Underpaid claims are together with appeal request in line with enterprise/client’s policy. 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
tr%20medical%20coding%20and%20claims%20processing%20nc%20iii.docx