Clinical Coder

Overview

• 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.