Establish and maintain the diagnostic/procedural coding system as approved by the hospital’s medical/administrative directive and Dubai Health Authority
Code all relevant, current and documented diagnoses and procedures as performed by attending physicians utilizing the appropriate ICD coding
Abstract all demographic, statistical and medical information from each patient record and enter the data into the coding/abstracting system
Review Claims for all prescribed diagnostics and pharmacy items along with procedures and complications as documented in the EMR, Claim Form/ operative reports. Assign appropriate codes and send a request to physician wherever required.
Apply the appropriate guidelines for assignment of principal and secondary procedures utilizing the CPT 4 procedure code when reviewing claims with Inpatient Coordinator for billing purposes/DRG billing. Assign Initial DRG and Final DRG
Responsible for thoroughly knowing and utilizing all coding systems both inpatient and outpatient according to the most recent rules, regulations, and conventions.
Review rejections and resubmit such claims from payers and assign appropriate codes based on response from physicians for queries raised after rejection
Review scrubber software report details & amend the coding in HIS based-on query response and documentation in EMR
Provide technical guidance to physician’s and other departmental staff in identifying and resolving issues or errors such as Incomplete or Missing records and documentation, ambiguous or nonspecific documentation, or codes that do not confirm to approved coding principles/guidelines
Prepare and update exclusions by Payers based on ICD10 codes and CPT
Prepare benefit plans based on insurance contracts
Prepare monthly claims for E submission and monthly reports of productivity and completion of coded batches
Job Responsibilities:
Communication (with patients and Insurance Companies)
Compliance to policies/regulation
Participation in organization wide initiatives
People/team Orientation
Problem Solving / Decision Making
Quality (Claims analysis / reconciliations)
Technical/ Business Knowledge (Hospital Policies and Insurance Company policies)
Education:
Graduation in Allied Health
Diploma in Equivalent or CCS
Experience:
A minimum of 3+ years’ experience of working in Coding Company/Medical record or RCM department.
A minimum of 1 years’ experience of Revenue Cycle Management in Dubai
Skills:
Ability to solve problems and execute on initiatives.
Ability to work on Microsoft excel (extensive).
Ability to work collaboratively internally and externally.
Ability to analyse trends for claims rejections based on physician documentation, ICD 10 and CPT.
Demonstrated organizational and interpersonal skills.
Ability to interpret E claims data.
Ability to understand medical terminology and billing terminology.
