Insurance Drg Coder - Dubai, United Arab Emirates - QMI Healthcare
Description
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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