Medical Coder/biller
7 months ago
Key Responsibilities:
- Deliver high quality customer service and respect medical & work ethics at all times.
- Ensure that business decisions & processes are documented in a professional way, adhering to Insurance company’s communication requirements.
- Interact with medical units to capture the needs for new or changes guidelines and training & evaluation.
- Carry out ongoing medium to complex activities.
- Develop medical guidelines (and accompanying rules) in line with the end-to-end process view of the company (note: for medium to complex cases).
- Assist in documenting the medical decision process, evaluating the completeness of guidelines and prioritizing/sequencing the development of new guidelines.
- Quantitative analysis - Perform a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
- Qualitative analysis - Evaluate the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review the records for compliance with established third party reimbursement agencies and special screening criteria
- Receive the patient medical record on daily basis and check any deficiency in documentation, if any, notify the concerned staff and send it to physician
- Receive the completed records and ensure that the marked deficiencies are cleared and are in compliance with the standards
- Ensure all records are deficient free
- Evaluate & report of the effect of implemented guidelines and rules/procedures.
- Identify and support improvement opportunities for the unit.
- Provide support to strategic medical initiatives under supervision of the Manager.
- Perform such other duties as may be assigned from time to time.
- Prepare and submit all claims related reports and monthly insurance MIS.
- Assign ICD-10-CM codes for the diagnosis with maximum specificity and accuracy as per coding guidelines and make sure that codes are marked in Claims Module.
- Assign appropriate CPT and DRG codes for special procedures as per guidelines
- Ensure the ICD 10 CM codes and CPT codes of patient encounter in records and the system is same
- Ensure all the patient encounters of the previous date are coded as per ICD-10-CM and E/M codes on or before 5th of each month to send the data to DHPO and insurance submission
- Responsible for any queries regarding coding from insurance companies
- Prepare and report all non-coding compliance and documentation deficiencies, particularly in related to insurance claims.
Qualifications:
- Bachelor’s Degree in any field
- Certification in Medical Coding (CCA) is mandatory.
- minimum of Three (3) years’ experience (preferably in Healthcare industry)
- Maintains high level of accuracy at work
Ability to commute/relocate:
- Dubai: Reliably commute or planning to relocate before starting work (required)
License/Certification:
- Certicifation in Medical Coding (required)
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