Excellent domain expertise and process knowledge of RCM for Hospital facility.
Understanding of Hospital Facility IP DRG coding concepts, MS DRG, APR DRG, reimbursement methodology, ICD-10-CM, ICD-10-PCS guidelines, elements of UHDDS guidelines, query processes, documentation guidelines.
Strong knowledge in human anatomy, physiology, pathophysiology, pharmacology, diagnostic studies, conservative and surgical treatments. Understanding of all document types, Operative Reports, Discharge Summary, Progress Notes, ED Report and all other report formats used in hospital care setting.
Understanding of CMS IPPS payment methodologies
Aware of consequences of risky practices like up-coding and down-coding, fraud and abuse, inflated documentation, OIG guidelines, and HIPAA rules.
Skills
Strong interpersonal skills, excellent communication skills, and ability to effectively work with and coach team members.
Ability to communicate with other stakeholders and clients, MIS team, and training teams for driving quality management.
Possess operational skills to manage team with better resource utilization.
Should have an aptitude to learn new things. Ability to read, writes, and performs basic computer operations. Must be a self -starter, motivated, organized and able to prioritize tasks.
Managing reports daily, weekly, monthly and monitoring and being active participant in client calls and maintaining good client relationship.
Research, analyze and respond to inquiries regarding compliance,
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