Insurance Drg Coder

1 week ago


Dubai, Dubai, United Arab Emirates QMI Healthcare Full time

Primary Responsibilities:

  • Must have appropriate DRG knowledge and experience
  • The Coder must undertake a thorough review of applicable documentation to assess the documentation requirement and determine the appropriate ICD10CM and/or CPT4/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.
  • 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.

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