Job description

Duties & Responsibilities:

• Performing data entry of client information for billing
• Generating, updating, and maintaining patient profiles for both current and new clients
• Responsible for the submission of required reports for approval/re-approval while coordinating with supervisors
• Demonstrating professional demeanor over the phone and providing customer service while making claim inquiries
• Resolving patients’ complaints and concerns
• Demonstrating strong attention to details and the ability to multi-task within a fast-paced work environment
• Ensuring the completeness of all insurance forms and sub-forms
• Providing high quality submissions at all times
• Preparing and submitting claims for payment in a timely manner
• Responding to inquiries regarding accounts
• Posting cash receipts as received, if any
• Completing accounts receivable and accounts payable reports
• Monitoring accounts receivable and outstanding insurance claims
• Maintaining a minimum balance in outstanding accounts
• Preparing claims and reports as requested by management and as scheduled
• Creating, maintaining, and updating billing manuals with new or changing rules and regulations
• Attending provider billing training as needed for updates
• Maintaining current expertise in billing and collections
• Maintaining confidentiality of client and personnel information
• Performing job functions in compliance with regulations and agency policies and standards
• Tracking and cross-checking all forms, claimed amounts, level of care, duration of care, etc.
• Performing other duties as assigned

Other Duties:

• Audits records to ensure proper submission of services prior to billing on pre-determined selected charges 
• Receives hospital information to properly bill provider services for home care patients 
• Supplies correct ICD-10-CM 2015 diagnosis codes on all diagnoses provided
• Supplies correct HCPCS code on all procedures and services performed 
• Supplies correct CPT code 2011 on all procedures and services performed 
• Contacts providers to train and update them with correct coding information 
• Attends seminars and in-services as required to remain current on coding issues 
• Audits medical records to ensure proper coding completed and to ensure compliance with regulatory bodies 
• Accurately follows coding guidelines and legal requirements to ensure compliance with regulatory bodies 
• Maintains all mandatory in-services 
• Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. 
• Reports compliance problems appropriately. 
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. 
• Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered. 
• Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria. 
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.

Qualifications:

• Medical Bachelor Degree - BS Nursing preferred
• Working knowledge of the billing process in a healthcare setting in the Emirate of Abu Dhabi
• CPC - Certified Professional Coder or CCSPB-Certified Coder Specialist Physician Based
• Minimum of 1 year experience in billing, in a Home Care setting 
• Must have a TASNEEF, JAWDA & DOH Audit exposure
• Not less than two years medical coding experience post qualification in appropriate setting