Job Description

Responsibilities

• Claims Auditing and Analysis:
  • Audit outpatient claims to ensure accuracy in coding, billing, and documentation.
  • Review denied claims to identify root causes and trends (e.g., coding errors, eligibility, medical necessity).
  • Perform audits on processed claims to confirm compliance with DOH, DHA, and MOH guidelines.
  • Ensure proper application of CPT, ICD-10-CM, HCPCS, and other coding standards.
• Denial Analysis and Management:
  • Analyse denial trends and patterns to identify areas for improvement.
  • Collaborate with the coding and resubmission teams to address common denial reasons.
  • Develop and implement strategies for resubmission of denied claims, ensuring maximum reimbursement.
• Coding and Documentation Support
  • Verify the accuracy and completeness of coding (CPT, ICD-10, HCPCS) used in outpatient claims.
  • Provide recommendations and corrections to improve documentation for accurate billing.
  • Work with clinicians and administrative teams to ensure proper documentation practices.
• Training and Process Improvement:
  • Conduct training sessions for teams on claim submission, denial handling, and coding updates.

Qualifications

Education and Certification:

• Bachelor’s degree in a science-related field or Paramedical studies.
• Certification in medical coding (e.g., CPC, CCS) is required

Knowledge and Skills:

• Strong knowledge of UAE healthcare regulatory frameworks (DOH, DHA, MOH).
• Proficiency in coding standards (CPT, ICD-10-CM, HCPCS) and denial codes.
• Experience in analyzing denials and resubmission strategies.
• Familiarity with healthcare billing systems and RCM software.
• Excellent analytical and problem-solving skills.
• Strong communication and interpersonal skills for collaboration and training purposes.

Experience:

• A minimum of 5 years of relevant experience, with at least 3 years in the UAE market