Medical Coder
Dubai, United Arab Emirates
Job Description
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- Follow the mandatory SOP, checklist and relevant payer and coding guidelines.
- Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)
- Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.
- Supporting details/ justification available in EMR of all investigation done.
- Checking all CPT codes entered are correct based on CPT guidelines.
- Checking excluded ICD and CPT based on Coding guidelines.
- Approved services and rendered services are match.
- Ensuring all requested investigations are done and invoiced.
- Check the claim with correct Receiver and Payer name before finalizing the bill.
- Check the claim with correct Patient Copay application.
- Ensure all claims are submitted to insurance company.
- Check the payer\xe2\x80\x99s name, rate plan and plan name selected properly.
- Sharing the correction details to respective clinic team.
- Once the correction details shared to clinic the very next day need to cross verify whether the errors are corrected or not, if not corrected follow up with clinic team.
- Maintain Production sheet.
- Allocate production claims details to submission team based on the claims generated data.
- Every month create production excel and document each staff wise daily production count.
- Sharing of daily production details and claims status to Sir JP.
- Maintain monthly Claims status.
- Downloading 15 facilities claims generated count and update in the claim\xe2\x80\x99s status excel daily.
- Based on the data maintain finalized claims and pending claims details in the same excel.
- Maintain Correction claims details.
- Monthly Create new folder in the sharing folder to maintain correction details for each centre wise.
- Maintain List of claims generated before finalization vs finalized statement.
- Sending of monthly finalized report to Recon.
- Once the submission is finalized, reports need to share to recon team.
- Update the Insurance company protocol guidelines excel if any additional information were sent.
- If any updates from Insurance company, disseminate the information to all submission team.
- Respond to the queries from Clinic.
- Will get calls from clinics regarding claims related queries. Give them clear answer for the queries.
- Paper claims submission details.
- Corporate companies claim details and some time under insurance claim also should submit as paper claim especially Aetna \xe2\x80\x93 Al Ain Ahlia. So need to prepare the statement and covering letter and send to the insurance company as courier.
- Monitor Submission team and audit the claims randomly.
- Monitor the uploading claims from uploading team.
- Technical and Medical Errors
- Any Bachelor degree (preferably with Medical background)
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Job Detail
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Job IdJD1639978
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IndustryNot mentioned
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Total Positions1
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Job Type:Full Time
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Salary:Not mentioned
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Employment StatusPermanent
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Job LocationDubai, United Arab Emirates
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EducationNot mentioned