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Medical Coder

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NMC Healthcare

28d ago

  • Job
    Full-time
    Junior, Mid & Senior Level
  • Customer Relations
    Healthcare
  • Dubai

AI generated summary

  • You should follow coding guidelines, ensure accurate documentation and claims, maintain production and correction records, and hold a Bachelor/Diploma with AAPC coding certification.
  • You will ensure accurate patient documentation, verify coding compliance, maintain claims records, submit claims to insurers, track production data, and manage correction claims efficiently.

Requirements

  • Follow the mandatory SOP, checklist and relevant payer and coding guidelines.
  • Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)
  • Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.
  • Supporting details/ justification available in EMR of all investigation done.
  • Checking all CPT codes entered are correct based on CPT guidelines.
  • Checking excluded ICD and CPT based on Coding guidelines.
  • Approved services and rendered services are match.
  • Ensuring all requested investigations are done and invoiced.
  • Check the claim with correct Receiver and Payer name before finalizing the bill.
  • Check the claim with correct Patient Copay application.
  • Ensure all claims are submitted to insurance company.
  • Check the payer’s name, rate plan and plan name selected properly.
  • Maintain Production sheet
  • Allocate production claims details to submission team based on the claims generated data.
  • Every month create production xl and document each staff wise daily production count.
  • Sharing of daily production details and claims status to Sir JP.
  • Maintain monthly Claims status
  • Downloading 16 facilities claims generated count and update in the claim’s status XL daily.
  • Based on the data maintain finalized claims and pending claims details in the same xl.
  • Maintain Correction claims details
  • Monthly Create new folder in the sharing folder to maintain correction details for each centre wise.
  • Share the correction details to respective clinic team.
  • Bachelor / Diploma or related
  • AAPC Coding

Responsibilities

  • Follow the mandatory SOP, checklist and relevant payer and coding guidelines.
  • Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)
  • Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.
  • Supporting details/ justification available in EMR of all investigation done.
  • Checking all CPT codes entered are correct based on CPT guidelines.
  • Checking excluded ICD and CPT based on Coding guidelines.
  • Approved services and rendered services are match.
  • Ensuring all requested investigations are done and invoiced.
  • Check the claim with correct Receiver and Payer name before finalizing the bill.
  • Check the claim with correct Patient Copay application.
  • Ensure all claims are submitted to insurance company.
  • Check the payer’s name, rate plan and plan name selected properly.
  • Maintain Production sheet
  • Allocate production claims details to submission team based on the claims generated data.
  • Every month create production xl and document each staff wise daily production count.
  • Sharing of daily production details and claims status to Sir JP.
  • Maintain monthly Claims status
  • Downloading 16 facilities claims generated count and update in the claim’s status XL daily.
  • Based on the data maintain finalized claims and pending claims details in the same xl.
  • Maintain Correction claims details
  • Monthly Create new folder in the sharing folder to maintain correction details for each centre wise.
  • Share the correction details to respective clinic team.

FAQs

What are the primary responsibilities of a Medical Coder in the submission team?

The primary responsibilities include following mandatory SOP and coding guidelines, checking patient demographics, ensuring proper documentation in EMR, validating CPT and ICD codes, ensuring approved services match rendered services, and submitting claims to the insurance company.

What qualifications are required for this position?

A Bachelor’s or Diploma in a related field along with AAPC Coding certification is required.

How is the production of claims tracked in this role?

The submission supervisor maintains a production sheet, allocates claims details, and documents staff-wise daily production counts, which are shared monthly.

Is there a checklist for the submission supervisor's responsibilities?

Yes, the checklist includes maintaining production sheets, tracking claims status, downloading claims counts, maintaining correction details, and sharing this information with respective clinic teams.

What is the procedure for checking CPT codes?

The Medical Coder is responsible for ensuring that all CPT codes entered are correct based on CPT guidelines and checking for any excluded ICD and CPT codes according to coding guidelines.

How does the Medical Coder ensure that all investigations are invoiced correctly?

The Medical Coder checks to ensure that all requested investigations have been completed and invoiced accurately.

What actions are taken to verify claims before submission?

Claims are checked for the correct receiver and payer name, correct patient copay application, and ensuring all claims are submitted to the appropriate insurance company.

How does the Medical Coder handle correction claims?

The submission supervisor maintains correction claims details in a specific folder by center and shares them with the relevant clinic team.

What tools are used for keeping track of claims status?

Claims status is maintained using Excel spreadsheets to document finalized claims, pending claims, and correction claims.

Who is responsible for sharing daily production details and claims status?

It is the responsibility of the submission supervisor to share daily production details and claims status with Sir JP.

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NMC Healthcare

Delivering personalised care that matters.

Science & Healthcare
Industry
10,001+
Employees
1974
Founded Year

Mission & Purpose

NMC Healthcare is one of the largest private healthcare networks in the United Arab Emirates, and the third largest in Oman. Since 1975, we have provided high quality, personalised, and compassionate care to our patients and are proud to have earned the trust of millions of people in the UAE and around the world. ---------------------------------------- DISCLAIMER: Fraudulent Job Offers ---------------------------------------- It has come to our attention that fake job offers have been circulated under the name of NMC Healthcare by certain individuals/entities claiming that they are representatives or subsidiaries or under contract with NMC Healthcare. If you receive any unauthorised, suspicious, or fraudulent offers or interview calls, please send an email to verification@nmc.ae for formal verification. If you believe you have been a victim of a recruitment fraud, you are encouraged to approach the law enforcement agencies immediately.