Job Description

Manages staff who review, interpret, code and abstract medical records information according to standard classification systems. Performs the most advanced medical records coding and abstraction duties. Performs data quality reviews and prepares complex reports as required. Supports the activities of the Revenue Management and Finance Departments to ensure that all e-claims data is submitted regularly through the Dubai Health Authority (DHA) e-claims weblink with quality.

• Abstracts periodic data of claims which requires coding completion and assigned to the particular team based on the set criteria such as but not limited to the type of encounter inpatient (IP)/outpatient (OP)/day case (DC), Insurance companies, financial implications etc.
• Ensures that the claims are coded completely before assigning the claims to the submission work queue.
• Manages a wide range of activities about reviewing and coding inpatient and outpatient medical record information.
• Establishes and maintains the diagnostic/procedural coding system as approved by the hospitals and regulatory governing bodies' medical/administrative directives.
• Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.
• Performs data quality reviews on inpatient and outpatient records to validate that both International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10 CM) and Current Procedural Terminology (CPT) are reported to the highest specificity and must verify Diagnosis Related Group (DRG) group appropriateness.
• Creates and monitors inpatient case mix reports and the top DRGs in the facility to identify patterns, trends and variations in the facility’s frequently assigned DRG groups under the supervision of the department director; investigates and evaluates potential causes for changes or problems; takes appropriate steps in collaboration with the right staff to effect resolution or explain variances.
• Evaluates the quality of clinical documentation to identify incomplete or inconsistent documents for inpatient and outpatient encounters that impact the code selection and result in decreased/inappropriate payment.
• Provides or arranges for training of facility healthcare professionals in the use of technical coding guidelines and practices, proper documentation techniques etc as required/periodically.
• Maintains knowledge of current and required coding certifications as appropriate; performs the most technical complex and difficult coding and abstraction work.
• Selects, assigns, and trains subordinate technical and clerical staff; manages, monitors, and evaluates work; reviews and makes decisions regarding leave requests, assists with and promotes the recruitment and retention of qualified staff as assigned.
• Demonstrates and maintains competency in the use of computer applications, particularly the coding and abstracting software and hardware currently in use by the Health Information Management division.
• Recommends and implements standardized, organization-wide coding guidelines and documentation requirements Under the supervision of the Director; develops and implements training and educational programs for physicians and coders.
• Ensures relevant Physician Queries are sent by the team and keep track of the same for future reference.
• Takes part in the department’s payer/regulatory audit and represents the facility in front of them with sound knowledge and should be able to negotiate on the identified remarks by them.
• Maintains confidentiality regarding department activities.
• Performs other related duties as assigned.
• Bachelor's Degree in Health Information Technology or healthcare-related field
• Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Procedural Coder (CPC)
• Certified Professional Medical Auditor (CPMA) or Certified Documentation Improvement Practitioner (CDIP) preferred

PROFESSIONAL EXPERIENCE:

• Minimum of eight (8) to twelve (12) years of experience in a Medical Records department.
• Knowledge of anatomy, physiology, medical terminology and pathophysiology.
• Skills in International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) or International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) coding, Current Procedural Terminology (CPT) coding, and Diagnosis-Related Group (DRG) coding.
• Skills in utilizing health information systems (HIS) software.