IP DRG coder

Medical Coding is the process where the medical record and claim documentation are checked and medical diagnostics, treatments and procedures (medical services) are converted to universal alphanumeric codes. This is one of the intermediate steps in processing claims. These codes form part of data collection which is used for research, funding and healthcare planning.

Role

Summary:

The Team Lead role is responsible for providing leadership and management of day-to-day operations that result in the provision of an efficient, effective accurate and timely clinical coding service.

To be successful in the role, an excellent understanding of clinical coding requirements is necessary as is the ability to communicate these to the team and other stakeholders as appropriate. Vigilant monitoring, from a quality assurance perspective is essential to ensure coding is accurate and of high quality

Primary Responsibilities:

• Ensures an accurate, efficient and effective and timely team approach to daily operations of the clinical coding service. Coding will be of high quality
• Contributes to the development of staff capabilities to meet company goals and objectives
• Ensures clinical coding team provides excellent customer service at all times to internal and external customers
• Lead and promotes a team environment that enhances partnership and cooperation through effective liaison, communication and an inclusive approach
• Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered - assigning ICD and CPT codes based on the medical documentation
• Applying the relevant code sets, keeping in mind the trends for denials and non-payments in relation to detailed data needed to describe and notify services as rendered within the Insurance scenario
• Understand the individual client payer contracts as to be able to process claims in submission and resubmission based on the same
• Be able to adjudicate the medical necessity for a given IP claims.
• Have complete knowledge of billing guidelines of the provider and payer
• Audit all high value claims and ensure accuracy of coding
• To analyze the completeness of the EMR and suggest remedies.
• Analyze rejections received from payers and help the managers to train the facility/ physicians to overcome these.

Job Requirements:

• Bachelor in Life Sciences
• Relevant coding certification with up-to-date membership to a body as accepted by the geographical governance area
• Certified coding Specialist (CCS) or certified professional coder (CPC)
• Relevant experience of at least 5 years in insurance claims management
• UAE experience of a minimum of 3 years mandatory
• Experience managing Staff is desirable
• Excellence in MS office and Data Management

Key Performance Indicators (KPI's).

• Meeting the set targets for processing the claims
• Meet the client set KPI for initial Rejection rates
• Maintain the 95% quality for processing claims.