مرمّز طبي – إعادة تقديم المطالبات

Overview

M42 delivers comprehensive healthcare services across the full continuum of care; from primary care to advanced specialty treatments. Leveraging cutting-edge health technologies and precision medicine, we ensure the highest standards of effectiveness, efficiency, and patient-centered outcomes. With a global presence spanning more than 480 facilities in 27 countries and a dedicated workforce of over 20,000 professionals, M42 is uniquely positioned to redefine the future of healthcare on a global scale.

Danat Al Emarat is a world-class specialty women’s and children’s hospital in the Emirate of Abu Dhabi. It offers advanced medical services across specialties including Neonatology, Pediatrics, Obstetrics & Gynecology, and Women’s Health. The hospital is one of the very few to encompass a dedicated Fetal Medicine Department along with a full-fledged Neonatal Intensive Care Unit (NICU) in the UAE. This has established Danat Al Emarat as a regional referral center for women with high-risk pregnancies, supported by its Level III NICU providing care for the most fragile newborns.

The Medical Coder - Resubmission is responsible for reviewing, correcting, and resubmitting denied, rejected, or unpaid insurance claims to ensure timely and accurate reimbursement. The role involves analyzing claim denials, verifying coding accuracy, identifying documentation gaps, and implementing corrective actions in accordance with payer requirements and regulatory guidelines. Working closely with physicians, coding specialists, billing teams, and revenue cycle staff, the Medical Coder - Resubmission plays a critical role in minimizing revenue loss, improving claim acceptance rates, and supporting the financial performance of the organization while maintaining compliance with healthcare coding and billing standards.

Responsibilities

• Review denied, rejected, and unpaid claims to identify the root cause of claim failure and determine appropriate corrective actions.
• Analyze medical records, coding, billing information, and supporting documentation to ensure accuracy and compliance with payer requirements.
• Correct coding, demographic, authorization, eligibility, and billing errors prior to claim resubmission.
• Resubmit claims accurately and within payer-defined timelines to maximize reimbursement and reduce revenue loss.
• Ensure diagnosis and procedure codes are assigned in accordance with ICD-10-CM, CPT, HCPCS, and applicable coding guidelines.
• Investigate payer denials and underpayments, identify trends, and recommend process improvements to reduce recurring issues.
• Collaborate with physicians, coders, billing teams, and revenue cycle staff to obtain clarification and supporting documentation when required.
• Prepare and submit appeal requests for denied claims with appropriate clinical and financial documentation.
• Monitor the status of resubmitted claims and follow up with insurance companies to ensure timely resolution.
• Maintain accurate records of denial reasons, resubmissions, appeals, and claim outcomes.
• Support internal and external audits by providing documentation and explanations related to claim corrections and resubmissions.
• Ensure compliance with healthcare regulations, payer policies, and organizational procedures throughout the resubmission process.
• Generate reports on denial trends, resubmission volumes, recovery rates, and outstanding claims.
• Participate in quality improvement initiatives aimed at enhancing claim acceptance rates and reducing denials.
• Maintain productivity, turnaround time, and accuracy standards established by the organization.
• Stay updated on payer policy changes, coding updates, and reimbursement regulations affecting claim resubmission activities.

Qualifications

• Bachelor's degree in Health Information Management, Medical Records, Healthcare Administration, Nursing, Pharmacy, or a related healthcare field.
• Professional coding certification such as CPC (Certified Professional Coder)
• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding systems

• Review denied, rejected, and unpaid claims to identify the root cause of claim failure and determine appropriate corrective actions.
• Analyze medical records, coding, billing information, and supporting documentation to ensure accuracy and compliance with payer requirements.
• Correct coding, demographic, authorization, eligibility, and billing errors prior to claim resubmission.
• Resubmit claims accurately and within payer-defined timelines to maximize reimbursement and reduce revenue loss.
• Ensure diagnosis and procedure codes are assigned in accordance with ICD-10-CM, CPT, HCPCS, and applicable coding guidelines.
• Investigate payer denials and underpayments, identify trends, and recommend process improvements to reduce recurring issues.
• Collaborate with physicians, coders, billing teams, and revenue cycle staff to obtain clarification and supporting documentation when required.
• Prepare and submit appeal requests for denied claims with appropriate clinical and financial documentation.
• Monitor the status of resubmitted claims and follow up with insurance companies to ensure timely resolution.
• Maintain accurate records of denial reasons, resubmissions, appeals, and claim outcomes.
• Support internal and external audits by providing documentation and explanations related to claim corrections and resubmissions.
• Ensure compliance with healthcare regulations, payer policies, and organizational procedures throughout the resubmission process.
• Generate reports on denial trends, resubmission volumes, recovery rates, and outstanding claims.
• Participate in quality improvement initiatives aimed at enhancing claim acceptance rates and reducing denials.
• Maintain productivity, turnaround time, and accuracy standards established by the organization.
• Stay updated on payer policy changes, coding updates, and reimbursement regulations affecting claim resubmission activities.

• Bachelor's degree in Health Information Management, Medical Records, Healthcare Administration, Nursing, Pharmacy, or a related healthcare field.
• Professional coding certification such as CPC (Certified Professional Coder)
• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding systems