Job Description

Job Family Summary

The Operations Department is responsible to manage all aspects of claims management including Onsite operations and back end processing. The department primarily works on main objective of submitting the claims in time with highest quality to ensure the client receives the payment with minimal or no rejections.

Role Summary

Medical Coding is the process where the medical record and claim documentation are checked and medical diagnostics, treatments and procedures (medical services) are converted to universal alphanumeric codes. This is one of the intermediate steps in processing claims. These codes form part of data collection which is used in research, funding and healthcare planning

The Senior Associate - Coder is responsible for analyzing the claim and applying the relevant coding to the claims based on the individual providers manual and as per the coding rules governing the specific compliance in relation to coding guidelines for the specific geographical area in such a way that optimal compliance is achieved and optimal revenue is obtained .

Primary Responsibilities

• Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered - assigning ICD and CPT codes based on the medical documentation
• Applying the relevant code sets, keeping in mind the trends for denials and non-payments in relation to detailed data needed to describe and notify services as rendered within the Insurance scenario
• Understand the individual client payer contracts as to be able to process claims in submission and resubmission based on the same
• Be able to adjudicate the medical necessity for a given claims OP or IP
• Have complete knowledge of billing guidelines of the provider and payer
• Capture all embedded services in the EMR
• To analyze the completeness of the EMR and suggest remedies
• Must have knowledge in UAE pre-approval protocols
• Must able to analyze denials, identify root cause methods to improve them
• Should able to work as mentor and monitor team if required
• Able to communicate and provide feedback for payer related audits

Job Requirements

• Bachelor in Life Sciences
• Relevant coding certification with up to date membership to a body as accepted by the geographical governance area
• Relevant experience of at least 3 years in insurance claims management
• UAE experience of a minimum of 3 years mandatory
• Must be flexible to relocate

Key Performance Indicators (KPI's)

• Meeting the set targets for processing the claims
• Meet the client set KPI for initial Rejection rates
• Maintain the 95% quality for processing claims.