Job Description
Reporting to the Senior Medical/Clinical Coder Coding Supervisor, the Medical Coderrole is responsible for reviewing coding of medical cases, handling claims submission to payers, and all revenue cycle/billing tasks assigned. The role is also responsible in ensuring the accuracy of the coding in patient health records.
Medical Coder Responsibilities
- Reviews medical records documented by physicians, nurses and other clinical staff and ensures all medical records are in place with no missing documentation.
- Validates physicians’ clinical documentation data quality and provides documentation tips/training to concerned staff for improved reporting to senior management.
- Provides data to authorized personnel for studies and/or research purposes.
- Assists in external medical audits by coordinating with the auditors and providing access to the required medical records.
- Performs periodic internal audits to improve and sustain quality levels and compliance.
- The incumbent checks and sequences the most accurate ICD10-CM/CPT/HCPCS/DRG/Other codes for diagnoses and procedures for documented information.
- Assures the final diagnoses and operative procedurestated by the physician are valid and complete.
- Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
- Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Computes and gives the correct DRG coding for all inpatients cases.
- Query physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for resubmission purposes.
- Ensures coding as per DOH/DHA guidelines and regulations.
- To perform any other duty as required by the line manager or supervisor that commensurate with the post.
Qualifications
- Bachelor’s Degree in Health Information Management or any relevant fields
Experience
- Minimum 4-5 years of progressive career experience
- Relevant experience in a hospital/medical center environment within UAE
Certification and Licensure
- Coding certificate by AAPC / AHIMA
Job Specific Skills and Abilities
- Knowledgeable of DOH/DHA and HIPPA rules and regulation
- Strong analytical and problem-solving skills
- Proficiency with Microsoft Office suite
- Fluency in written and spoken English
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