The posting
Job Description
Ensures accurate assignment and verification of diagnosis and procedure codes following established coding guidelines and Dubai Health Authority (DHA) e-claims guidelines for all Hospital Claims including self-pay. Abstracts appropriate data for reporting from inpatient, day surgery, and outpatient encounters. Supports activities of the Revenue Cycle Management Department such as assigning procedural codes, Healthcare Common Procedure Coding System (HCPCS) codes and diagnosis codes at the preauthorization level.
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, Exclusions 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 EMR, Claim Form/ operative reports.
- Assigns appropriate codes and send a request to the physician wherever required.
- Ensures Documentation is completed and specific for coding to the highest specificity/severity.
- Applies the appropriate guidelines for the assignment of principal and secondary procedures utilizing the Current Procedural Terminology (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 like CT, MRI, and Surgical Procedures, etc. as per the Quick Chart/DPP.
- Prepares 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 are sought from the Physician/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.
- Maintains confidentiality regarding department activities.
- 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.
Qualifications
- 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 of 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 working with Microsoft Office applications (e.g. Excel, Outlook, and Word).
- Skills in Communication and Interpersonal preferred.
- Ability to speak and write in English fluently.
- Ability to communicate in Arabic preferred.
