Medical Coding Senior Executive

Ascribe Healthcare Solutions

The Senior Executive for Medical Coding will be responsible for reviewing, interpreting and abstracting clinical information from medical records and translate into international code sets by applying coding guidelines for reimbursement, research, and compliance, adhering to established coding principles and protocols.

Roles and Responsibilities

• Ensures appropriate selection of principal diagnosis, qualifying secondary diagnosis, Impacting procedures and other services which are relevant for submission and reimbursement

• Effective physician query process before code assignment to obtain the greatest possible diagnostic specificity and clinical documentation to accurately reflect the patient's condition

• Consistently maintain quality and productivity standards and achieve the productivity target and quality targets

• Ensures to reduce rejections and get the claim paid at the initial submission of claims

• Assign codes for preauthorization process and effective response to payer queries coordinating with the clinical team

• Applying advanced knowledge of medical terminology, anatomy, and physiology, treatment modalities, diagnostic test, medications.

• Ensure a high level of patient data confidentiality

• Identify documentation deficiencies and query physician for clarification and additional documentation before code assignment

• Perform other related duties incidental to the work described herein

• Ensures that targets are met for department Turnaround time, Quality and Productivity

• Adhere to the DHA Claims and Adjudication rules and coding guidelines

Education, Experience, and skills needed

• Education: Degree in any related field with medical/life science background

• CCS (AHIMA) or CPC (AAPC) certification is mandatory

• Minimum of two to three (2-3) years coding experience in any setting i.e., hospital, daycare center, or other related healthcare organizations in UAE is required

• Knowledge of the billing process will be desirable. Both inpatient (IR-DRG) and outpatient coding experience are mandatory.

• Expertise in medical record review to abstract information required to support accurate coding

• Excellent communication skills

• Good understanding of the preauthorization process and payer adjudication guidelines related to DHA

• Expertise in assigning accurate ICD-10-CM, CPT, DRG, HCPCS and other service codes for diagnosis and procedures performed in the IP/OP/ER setting.

• Excellent interpersonal skills while interacting with physicians, nurses and other staffs

• Multispecialty coding experience in surgery, IVR, labs, radiology and HCPCS coding for supplies & consumables

• Aware of current trends related to medical necessity, DRG, and DHA Claims and Adjudication rules and coding guidelines