Suganya

IP/OP Coding, facilitating physicians accessing HIS (SAP) and Educating physicians on documentation deficiencies, medical necessity. Claim submission and re-submission in clinic and pharmacy. Assigning proper ICD 10, CPT, CDT and DDC code for diagnosis procedures (medical & dental) and medicines respectively.

Responsible to facilitate correspondence between outpatient coders and the facility staff Educating physicians on documentation deficiencies, medical necessity and scope for improvement on claims rejection perspective. Communicating with physicians and others for the queries raised by the resubmission team and audit team.
Sharing audit findings, denials, and new coding and billing updates with the physicians. Physiotherapy/Dental coding, internal auditing, clearing accruals and claim validation. Receiving approvals from insurance companies through DHPO & insurance portals.
Advanced proficiency in MS Excel and xml editing and expertise in SAP software & 3M tool.

Claim submission and re-submission in clinic and pharmacy, paper claim submission. Assigning proper ICD 10, CPT, CDT and DDC code for diagnosis procedures (medical & dental) and medicines respectively. Calculating all elements and assigning the codes according to the provider's documentation as well as checking the medical necessity for ICD codes. CCI edits analysis of services. Re-submission of rejected claims with stipulated time period based on the remittance in DHPO. Ensuring E claims submissions of In-Patient, Out-Patient and pharmacy in three batches every month for 23+ Insurance companies and TPA. Expertise in HIS software Medas, Unite, Eclaim POS etc,.

Specialized in Coding ICD-10 CM, CPT, Evaluation and Management & ED, HCPCS and IP-DRG. Deployed under multiple US HCC Projects Aetna Medicare, Aetna Commercial, Molina, CHPW, Optum etc,.