Performs various tasks including assigning procedural codes, HCPCS codes, and diagnosis codes during pre-authorization. Ensures accurate code assignment following established guidelines and Dubai Health Authority e-claims guidelines, addresses rejections and reports trends for process improvement. Encodes diagnoses and procedures, abstracts patient information, understands insurance policies, and reviews electronic statements. Collaborates with physicians to ensure accurate documentation, applies coding guidelines, reviews approval tracks, and addresses coding edits for medical necessity. Monitors productivity and ensures timely closure and dispatch of insurance, corporate, and self-pay batches according to schedule.
- Supports activities of the Revenue Cycle Management Department such as assigning procedural codes, HCPCS codes and diagnosis codes at the pre-authorization level.
- Ensures accurate assignment and verification of diagnosis and procedure codes following established coding guidelines and Dubai Health Authority (DHA) e-claims guidelines for all Hospital Claims including self-pay.
- Establishes and maintains the diagnostic/procedural coding system as approved by the hospital’s medical/administrative directives.
- Reviews rejections from payers and assigns appropriate codes based on responses from physicians for queries raised after rejection.
- Reports Utilization Trends, Documentation Issues, and Billing Issues for Process/Performance Improvement.
- Encodes all relevant, current and documented diagnoses and procedures as performed by attending physicians utilizing the appropriate International Classification of Diseases (ICD) coding.
- Creates an abstract of all demographics, statistical and medical information from each patient record and enters the data into the coding/abstracting system.
- Understands Health Insurance Policy Terms, Coverage, Exclusions & Approval requirements as per the contractual and regulatory obligations.
- Reviews electronic statements for all prescribed diagnostics and pharmacy items along with procedures and complications as documented in the Electronic Medical Record (EMR), and claim form/operative reports.
- Assign appropriate codes and send a request to the physician wherever required.
- Ensures documentation is completed and specific for coding to the highest specificity/severity.
- Applies the appropriate guidelines for the assignment of principal and secondary procedures utilizing the CPT-4 procedure code when reviewing claims with the Outpatient Coordinator for billing purposes.
- Reviews approval tracks are entered for all approval-required services like Antenatal Consultations, Diagnostics such as CT, MRI, and Surgical Procedures etc. as per the Quick Chart/DPP.
- Ensures Billed Services should be as per the approval provided by the Insurer/Corporate.
- Reviews services are repeated within the same day and clarifications/medical necessity is sought from Physicians/Laboratory/Medical Imaging, etc.
- Reviews Coding Edit Engine of Dubai (CEED) filtered Medical necessity/coding edits and ensures additional ICD codes are applied as required/suggested by the Insurance Coordinator.
- Ensures physician queries are sent and reported.
- Ensures daily productivity is achieved.
- Ensures delegated Insurance, Corporate and Self-Pay batches are closed and dispatched in line with the dispatch schedule.
- Bachelor’s Degree in any field, Medical preferred
- Certified Coding Specialist (CCS) accredited by the American Health Information Association (AHIMA) or
- Certified Professional Coder (CPC) accredited by the American Academy of Professional Coders (AAPC)
PROFESSIONAL EXPERIENCE:
- Minimum zero (0) to one (1) year of experience in ICD-9-CM or ICD-10 coding in an organization handling claims
- Knowledge of Health Insurance Policy Terms, Coverage and Exclusions in the UAE preferred
- Skills in Microsoft Office (e.g. Excel, Word, PowerPoint, Outlook, etc.)
- Ability to speak and write in English
- Ability to communicate in Arabic preferred
American Hospital Dubai is committed to being an employer that helps its people realize their full potential and set benchmarks in medical care excellence. We offer an extremely progressive, nurturing, diversity-rich and inclusive work environment that encourages creativity and innovation to help you achieve the extraordinary.
We believe in supporting you every step of the way because we acknowledge the fundamental truth: each one of us wants to make a difference in the world.
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