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Case management of insured cases.
Ensuring submission of optimal documentation
Monitoring for correct coding and billing practices for inpatient and outpatient cases.
Rejection analysis
Healthcare provider monitoring and ongoing education
Minimizing DRG variances
DUTIES AND RESPONSIBILITIES
Promote quality and cost-effective interventions and outcomes.
Record case information, complete accurately all necessary forms and produce statistical reports.
Develop effective working relations and provide feedback to administrative, medical, and RCM team throughout the entire case management process.
Advise healthcare providers on correct documentation, optimal resource utilization and controlling outlier expenses.
Promote correct completion of documentation to ensure correct E&M coding, correct CMI calculation and DRG severity levels.
Advise departments on the optimal case mix.
Ensure minimal leakages of potential revenue.
Advise doctors on best practice trends.
Evaluate and develop training sections to avoid rejections.
Random file audits with regular feedback to concerned departments.
OSH ROLES AND RESPONSIBLITIES:
GENERAL:
SPECIFIC:
Sound clinical training and background.
Medical/ Allied Graduate.
Sound coding, Billing, auditing approval and clinical known.
International certification in coding.
Preferred auditing certification / Training.
Clinical experience of 5 year in hospital.
At least two years supervisory experience.
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