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 Associate Coder is responsible for 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.

Primary Responsibilities:

Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered.

• 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 so as be able to process claims in submission and resubmission based on the same
• Be able to process claims either in OP or IP scenario
• Analyze and communicate coding and billing issue of the provider to the supervisors.
• Have complete knowledge of billing guidelines of the provider and payer
• To assist with documentation review and raise queries on completeness of EMR
• The Coder must undertake a thorough review of applicable documentation to assess the documentation requirement and determine the appropriate ICD-10-CM and/or CPT-4/USCLS codes to be reported, in conjunction with the applicable version of Official Guidelines

Must observe AHIMA code of ethics while assigning relevant code sets.

Job Requirements:

Bachelor in Life Sciences

• Most relevant coding certification with updated membership to a body as accepted by the geographical governance area
• Relevant experience of at least 2 years in insurance claims
• A minimum of 2 years' experience and good knowledge of claims processing within UAE
• Experience in DRG coding will be an added advantage

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.