Job Description

Primary Responsibilities:

• Must have appropriate DRG knowledge and experience
• The Coder must undertake a thorough review of applicable documentation to assess the documentation requirement and determine the appropriate ICD-10-CM and/or CPT-4/USCLS codes to be reported, in conjunction with the applicable version of Official Guidelines.
• Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered.
• Understand the individual client payer contracts so as be able to process claims in submission.
• Be able to process claims either in OP or IP scenario
• Analyze and communicate coding and billing issue of the provider to the supervisors.
• Have complete knowledge of Coding & billing guidelines of the provider and payer.
• Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
• To assist with documentation review and raise queries on completeness of EMR
• Must also observe UAE code of ethics while assigning relevant code sets.
• Preapproval and Precertification for claims requiring approval.
• Making Cost estimates according to procedures
• Monitoring and follow up on prior authorization for outpatient/inpatient services
• Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer
• Contacting the payers/TPA for approval related matters. Communicates adequately with external parties.
• Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.
• Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution
• Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate
• Timely and meets deadlines.
• Reporting trends related to preapproval to reporting TL /Supervisor

Job Requirements:

• Bachelor in Life Sciences

• Most relevant coding certification with updated membership to a body as accepted by the geographical governance area (AAPC or AHIMA).
• Relevant experience of at least 1 year in medical coding.
• Should at least have basic knowledge of Evaluation and Management services. Prior hands on experience would be an added advantage.
• Experience in UAE coding will be an added advantage.

Job Type: Full-time Application Question(s):

• Do you have DRG coding experience?

Experience:

• DRG: 2 years (Required)

License/Certification:

• AAPC or AHIMA certification (Required)