Responsible for reviewing and analysing market payer and regulator protocols and review medical records in order to abstract relevant data to support the creation of rules to ensure appropriate codes are assigned in accordance with the Saudi clinical coding system and standards. THYNK Rules will support billing integrity and provide best practice support through working closely with payers, regulators, and healthcare providers revenue cycle departments to resolve coding/billing issues, Investigating and resolving issues and incidents leading to incompliance with regulatory policies or denials with payers in the market of Saudi Arabia.
Primary Responsibilities:
1. To act as a subject matter expert within the KSA Rules unit for all matters related to clinical coding queries under the Saudi Billing System, CCHI Coding Standards and Australian Coding Standards (ACS)
2. Manages integrity of Rules engine by defining the correct implementation of the
3. Ensures accurate coding as specified by established coding principles and guidelines.
4. Translation of region-based coding guidelines and local market practice into rule alerts by analysing ICD-10-AM (10th edition), ACHI and SBS codes (service codes) and drugs standards codes (HUMAN DRUGS LIST)
5. Email correspondence and troubleshoot with different departments for rule requests, suggestions, and queries.
6. Preparation of crosswalks analysing local market practice and Remittance advices.
7. Timely maintenance and scrubbing of engine as per coding and local market practice
Job Requirements:
1. Minimum 2-5 years experience as a Medical Coder in the Kingdom of Saudi Arabia
2. Medical Billing knowledge within private healthcare insurance sector required
3. Recognised Professional Certification in Medical Coding highly desirable
4. Candidate with past working experience with insurance payers background will be preferred
5. Should be well versed KSA local market regulations like CCHI, Health Council and SEBAHI
6. Excellent verbal/written communication and leadership skills
7. Proficiency in Healthcare Information Systems and Microsoft Office (Word, Excel, PowerPoint, etc.)
8. Bi-lingual Arabic/English preferred
9. Medical training as Doctor/Nurse/Pharmacist is highly desirable
SANTECHTURE is a healthcare technology innovator that is transforming Revenue Cycle Management (“RCM”) in the Middle East, North Africa and Asia through smart AI based and cloud-based solutions. SANTECHTURE’s Software as a Solution (“SaaS”) products help healthcare providers large and small, develop efficient Revenue Cycle Management to reduce cost, increase automation, maximize accuracy and safeguard revenue. Established in 2019, we have since grown to operate across KSA, UAE, India and Egypt serving a roster of blue-chip public and private sector customers and helping them to achieve RCM excellence, improve efficiency, accelerate collections and boost overall profitability.
