Clinical Abstraction assignments may include work from all lines of Company business (e.g., diagnostic auditing, HEDIS review, drug safety/efficacy studies). Each assignment will have specific requirements and time-lines.
• Diagnostic Coding: Clinical Readers review assigned medical records and apply appropriate diagnostic codes and modifiers according to Generally Accepted Medical Coding Guidelines, ICD-10-CM Guidelines and CMS Correct Coding Initiatives, coding guidelines approved by CMS, and all rules, regulations and guidelines promulgated by CMS and applicable to contractors and subcontractors of CMS-approved sponsors (collectively "Standards"), all as reasonably interpreted by the Company.
• HEDIS Reviews: Clinical Readers review assigned medical records and document measure specific clinical data according to NCQA technical specifications for hybrid medical records reviews.
• Health Outcomes Studies: Clinical Readers review assigned medical records and document relevant clinical data according to stated study objectives.
• Other specific details of the job will be made known to the employee by their immediate supervisor which may be in varying scope dependently on prevailing project undertakings.
• No Medical Coding experience required
• Active Medical Coding License by AAPC and /or AHIMA (i.e CPC-A, CRC) is required
• Working knowledge of scheduling, workforce management, time keeping and people management is ideal
• Excellent written and oral communication skills;
• Flexibility in work schedule to meet departmental needs.
• Proficiency in Microsoft Word, Outlook and Excel required
• Amenable to work in BGC,Taguig on a night shift schedule
Job Description :
To ensure customer service and support all operations. To create customer delight at every interaction.
Interacting with external customers and internal customers and addressing their queries, requests and complaints.
Committed TATs are met consistently
Complaints Management- addressing customer complaints at the branch, system updation, coordination with Sales/HUB/ other functions for resolution.
Refunds processing and dispatch
Undelivered policy documents tracking and management.
Maintenance of all files and registers.
New Business Processing:-
Handling end to end New business processing starting from creation of Client id,Case start up, New business login, Follow up for policy issuance, Quality Check
Follow up with HUB for policy issuance of pending cases