• Follow the mandatory SOP, checklist and relevant payer and coding guidelines.
• Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)
• Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.
• Supporting details/ justification available in EMR of all investigation done.
• Checking all CPT codes entered are correct based on CPT guidelines.
• Checking excluded ICD and CPT based on Coding guidelines.
• Approved services and rendered services are match.
• Ensuring all requested investigations are done and invoiced.
• Check the claim with correct Receiver and Payer name before finalizing the bill.
• Check the claim with correct Patient Copay application.
• Ensure all claims are submitted to insurance company.
• Check the payer's name, rate plan and plan name selected properly.

• Maintain Production sheet
• Allocate production claims details to submission team based on the claims generated data.
• Every month create production xl and document each staff wise daily production count.
• Sharing of daily production details and claims status to Sir JP.
• Maintain monthly Claims status
• Downloading 16 facilities claims generated count and update in the claim's status XL daily.
• Based on the data maintain finalized claims and pending claims details in the same xl.
• Maintain Correction claims details
• Monthly Create new folder in the sharing folder to maintain correction details for each centre wise.
• Share the correction details to respective clinic team.

• Bachelor / Diploma or related
• AAPC Coding

NMC Healthcare