أخصائي ترميز طبي

Encodes diagnoses and procedures using the International Classification of Diseases (ICD) coding system, abstracts patient information into a database, understands health insurance policies, reviews electronic statements for accuracy, assigns appropriate codes, ensures thorough documentation for coding accuracy, applies guidelines for billing purposes, tracking approvals for necessary services, confirming billed services align with insurer approvals, reviewing and seeking clarifications for repeated services, addressing coding edits, estimating costs for self-pay patients, sending physician queries, maintaining daily productivity, and ensuring timely closure and dispatch of insurance, corporate, and self-pay batches.

Responsibilities

• 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, Exclusion and 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.
• Assigns appropriate codes and send a request to the physician wherever required.
• Ensures documentations are 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.
• Estimates cost preparation received from different clinic teams for self-pay patients.
• 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.

Qualifications

• 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 one (1) to two (2) years 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