Position Description:

Performs various tasks including assigning procedural codes, Healthcare Common Procedure Coding System (HCPCS) codes, and diagnosis codes during pre-authorization and final coding. Ensures accurate code assignment following established guidelines and Dubai Health Authority e-claims guidelines, addresses rejections and reports erroneous documentation and billing trends for process improvement. Collaborates with physicians to ensure accurate documentation, applies coding guidelines, reviews approval tracks, and addresses coding edits for medical necessity and ensures timely closure and dispatch of insurance, corporate, and self-pay claims.

Position Responsibility:

•Supports coding activities of the Revenue Cycle Management Department by assigning diagnosis, procedural and HCPCS codes at pre-authorization, concurrent and final coding.

•Reports all relevant documented diagnoses and procedures as performed by physicians utilizing the appropriate code sets recommended by the regulator.

•Supports and assists in recovery audits by applying sound judgment, thereby reducing the risk of penalty/recovery

•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, Exclusions and Approval requirements as per the contractual and regulatory obligations.

•Initiates physician query if required and ensures the physician responds to the query with clarity.

•Ensures quality documentation is available to report the highest level of specificity/severity.

•Reports Utilization Trends, Documentation deficiencies, Billing discrepancies and audit findings for Process/Performance Improvement.

•Reviews approval tracks for all approval-required services like Antenatal Consultations and Diagnostics such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Surgical Procedures etc. as per the contractual agreements.

•Reviews Coding Edit Engine of Dubai (CEED) filtered Medical necessity/coding edits and ensures additional International Classification of Diseases (ICD) codes are reported as required.

•Trains physician and clinical team on documentation improvement practices.

•Liaises with medical records and hospital quality department in multi-disciplinary audits. 

•Provides cost estimates for elective admissions as required based on the hospital cost estimate policy.

Position Qualification:

•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 zero (0) to one (1) year 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.