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Medical Coder (IP DRG)/Pre-approval

1.00 to 10.00 Years   United Arab Emirates   07 Aug, 2022
ACCUMED
1 Jobs Openings
Job LocationUnited Arab Emirates
EducationNot Mentioned
SalaryNot Mentioned
IndustryOther Business Support Services
Functional AreaNot Mentioned

Job Description

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 planningThe 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:

  • 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.
  • Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered.
  • Understand the individual client payer contracts so as be able to process claims in submission.
  • 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 Coding & billing guidelines of the provider and payer.
  • Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
  • To assist with documentation review and raise queries on completeness of EMR
  • Must also observe UAE code of ethics while assigning relevant code sets.
  • Preapproval and Precertification for claims requiring approval.
  • Making Cost estimates according to procedures
  • Monitoring and follow up on prior authorization for outpatient/inpatient services
  • Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer
  • Contacting the payers/TPA for approval related matters. Communicates adequately with external parties.
  • Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.
  • Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution
  • Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate
  • Timely and meets deadlines.
  • Reporting trends related to preapproval to reporting TL /Supervisor
Job Requirements:
  • Bachelor in Life Sciences
  • Most relevant coding certification with updated membership to a body as accepted by the geographical governance area (AAPC or AHIMA).
  • Relevant experience of at least 1 year in medical coding.
  • Should at least have basic knowledge of Evaluation and Management services. Prior hands on experience would be an added advantage.
  • Experience in UAE coding will be an added advantage.
Key Performance Indicators (KPIs)
  • Meeting the set targets for processing the claims.
  • Meet the client set KPI for initial Rejection rates.
  • Maintain the 95% quality for processing claims.

Keyskills :

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