Medical Coder

Prime Healthcare Group

Job Title: Medical Coder

Job Description:

As a Medical Coder, your role is crucial in ensuring accurate clinical documentation, minimizing insurance rejections, and optimizing the billing process. You will collaborate with physicians, insurance teams, and other healthcare professionals to ensure proper coding and compliance with regulatory guidelines.

Key Responsibilities:

  1. Physician Collaboration:
    • Coordinate with physicians to ensure accurate clinical documentation, reducing the likelihood of insurance rejections and minimizing denials.
    • Provide feedback to healthcare providers regarding coding errors and areas of improvement in documentation.
  2. Insurance Authorization:
    • Collaborate with the Insurance team to identify procedures that require prior authorization before billing.
  3. Health Record Analysis:
    • Extract necessary information from health records to identify secondary complications and co-morbid conditions, which may impact coding accuracy.
  4. Compliance with Guidelines:
    • Ensure that all coding practices adhere to regulatory guidelines, especially those set forth by the Dubai Health Authority (DHA) or relevant authorities.
  5. Reporting:
    • Prepare statistical and analytical reports based on coded data, providing valuable insights for facility administration and opportunities for process improvements.
  6. Claims Submission:
    • Ensure the timely submission of medical claims to insurance companies by obtaining necessary referrals and pre-authorizations.
    • Review patient bills for accuracy, completeness, and compliance with relevant regulations.
    • Follow up on unpaid claims within standard billing cycle time frames.
    • Verify insurance payments for accuracy and compliance with any contract discounts.

Qualifications:

  • Relevant certification or training in medical coding.
  • Strong knowledge of coding guidelines, including DHA regulations (or applicable regional regulations).
  • Attention to detail and accuracy in coding and documentation.
  • Effective communication skills to collaborate with physicians, insurance teams, and other stakeholders.
  • Ability to prepare and present analytical reports.
  • Proficiency in using coding software and electronic health records systems.

As a Medical Coder, you play a critical role in ensuring proper coding, compliance, and accurate billing within a healthcare facility. Your attention to detail and adherence to guidelines are essential for optimizing revenue and providing high-quality healthcare services.

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