Coder-outpatient Claims Auditor

4 weeks ago

AlAyn, United Arab Emirates Kanad Hospital Full time

**Description**: The Outpatient Claims Auditor is responsible for reviewing, interpreting and abstracting clinical information from medical records for the purposes of reimbursement, research and compliance utilizing established coding principles and protocols.

**Job Functions and Key Accountabilities**:

- Expertise in medical record review to abstract information required to support accurate Outpatient coding
- Expertise in assigning accurate ICD-10-CM, CPT, DRG, HCPCS and other service codes for diagnosis and procedures performed in the Outpatient setting.
- Adhere to the DOH Claims and Adjudication rules and coding guidelines
- Acts as a resource when necessary for billing, pre-authorization and reimbursement issues and Inpatient coding.
- Excellent interpersonal skills while interacting with physicians, nurses and other staffs.
- Be a mentor for the team members and work with team to ensure high level of accuracy.
- Ensure high level of patient data confidentiality.
- Knowledge on Diagnosis related grouping
- Aware of current trends related to medical necessity, DRG and DOH Claims and Adjudication rules and coding guidelines
- Utilizes tools available in 3M to ensure accurate coding.
- Ensure knowledge on deductibles, co-payments, co-insurance amounts, insurance exclusions and other policies of all insurances that Kanad Hospital is dealing with.
- Critical thinker with ability to perform root cause analysis, prepare and implement action plans and lead improvement initiative.
- Query physician for clarification and additional documentation prior to code assignment.
- Perform other related duties incidental to the work described herein.

**Technical Competencies**:

- Ensures appropriate selection of principal diagnosis, qualifying secondary diagnosis, Impacting procedures, accurate E/M and others services which is relevant for submission and reimbursement.
- Effective physician query process prior to code assignment to obtain greatest possible diagnostic specificity and clinical documentation to accurately reflect the patient's condition. Consistently maintain quality and productivity standards and achieve the productivity target with desired quality of
- 90%.
- Ensures to reduce rejections and get the claim paid at the initial submission of claims.

**Qualification**:** Education**: Degree in any related field preferably life science background. CPC (AAPC) certification will be a plus.
**Experience**:** Experience**: Minimum of three (3) years Outpatient Claims Auditor experience in any setting i.e., hospital, clinic, or other related healthcare field is required. In addition to medical coding, knowledge of billing process will be a plus. Both inpatient and outpatient experience preferred.

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