Job Description

Roles & Responsibilities

• Encodes all relevant, current, and documented diagnoses and procedures as performed by attending physicians utilizing the appropriate International Classification of Diseases (ICD) coding.

• Creates an abstract of all demographics, statistical and medical information from each patient record and enters the data into the coding/abstracting system.

• Understands Health Insurance Policy Terms, Coverage, Exclusion and Approval requirements as per the contractual and regulatory obligations.

• Reviews electronic statements for all prescribed diagnostics and pharmacy items along with procedures and complications as documented in the Electronic Medical Record (EMR), and claim form/operative reports. 

• Assigns appropriate codes and send a request to the physician wherever required.

• Ensures documentations are completed and specific for coding to the highest specificity/severity. 

• Applies the appropriate guidelines for the assignment of principal and secondary procedures utilizing the CPT-4 procedure code when reviewing claims with the Outpatient Coordinator for billing purposes.

• Reviews approval tracks are entered for all approval-required services like Antenatal Consultations, Diagnostics such as CT, MRI, and Surgical Procedures etc. as per the Quick Chart/DPP.

• Ensures Billed Services should be as per the Approval provided by the Insurer/Corporate.

• Reviews services are repeated within the same day and clarifications/medical necessity is sought from Physicians/Laboratory/Medical Imaging, etc.

• Reviews Coding Edit Engine of Dubai (CEED) filtered Medical necessity/coding edits and ensures additional ICD codes are applied as required/suggested by the Insurance Coordinator.

• Estimates cost preparation received from different clinic teams for self-pay patients.

• Ensures physician queries are sent and reported.

• Ensures daily productivity is achieved. 

• Ensures delegated Insurance, Corporate and Self-Pay batches are closed and dispatched in line with the dispatch schedule.

Desired Candidate Profile

• Bachelor’s Degree in any field, Medical preferred

• Certified Coding Specialist (CCS) accredited by the American Health Information Association (AHIMA) or

• Certified Professional Coder (CPC) accredited by the American Academy of Professional Coders (AAPC)

PROFESSIONAL EXPERIENCE:

• Minimum one (1) to two (2) years of experience in ICD-9-CM or ICD-10 coding in an organization handling claims

• Knowledge of Health Insurance Policy Terms, Coverage and Exclusions in the UAE preferred

• Skills in Microsoft Office (e.g. Excel, Word, PowerPoint, Outlook, etc.)

• Ability to speak and write in English

• Ability to communicate in Arabic preferred