Medical Coder

Role Overview

The Medical Coder should ensure accurate clinical coding and timely claim submissions/resubmission. You protect revenue by reducing coding errors preventing denials and securing appropriate reimbursement. You ensure compliance with DHA regulations and payer requirements.

Key Objectives

Operational Accuracy

• Ensure precise CPT ICD and HCPCS coding for all outpatient encounters.
• Maintain zero tolerance for upcoding undercoding or unbundling.

Revenue Protection

• Achieve less than 5 percent denial rate related to coding errors.
• Ensure submissions/resubmission are completed within payer timelines.

Compliance

• Maintain audit ready coding documentation.
• Ensure adherence to DHA regulations and UAE payer policies.

Core Responsibilities

Clinical Coding

• Review patient medical records including physician notes test results charge tickets and other documentation from outpatient encounters.
• Ensure coding reflects medical necessity and supports billed services.
• Clarify incomplete or ambiguous documentation with clinicians.
• Apply payer specific coding guidelines and bundling rules.
• Assist with audits denial management education to providers on documentation best practices and reimbursement questions.
• Submission of Clean claims to insurance within the defined TAT.
• Resubmission of partially rejected claims with justification within defined TAT time.

Denial Analysis and Resubmissions

• Review rejected and denied claims to identify root causes.
• Correct coding errors and prepare compliant resubmissions; Draft appeal letters with clinical justification and supporting documents Track resubmission outcomes and escalate unresolved cases.

Documentation Integrity

• Ensure clinical notes diagnostic reports and orders support coded services.
• Validate alignment between coding authorization and billed services.
• Maintain organized digital records of denials corrections and appeals.

Payer and TPA Coordination

• Liaise with insurance companies and TPAs to clarify denial reasons.
• Communicate resubmission status to billing approvals team and management.
• Monitor payer policy updates and adjust coding practices accordingly.

Systems and Reporting

• Use HIS EclaimLink and payer portals to manage coding edits and resubmissions.
• Recommend process improvements to reduce recurring denials.

• Certified Professional Coder credential.
• Bachelors degree in Health Information Management Nursing or related field.
• Strong knowledge of DHA regulations and UAE payer rules.
• Minimum 2 years of coding and denial management experience in the UAE.
• Proficiency in EHR systems coding tools and Microsoft Office.
• Strong analytical skills and attention to detail.
• Effective communication with clinical billing and insurance teams.
• Experience in outpatient clinics or specialty centers preferably endocrinology or metabolic care.

Required Experience:

IC