SENIOR OFFICER - MEDICAL CODING
Abu Dhabi National Insurance Company
مجموع سنوات الخبرة :14 years, 2 أشهر
• Interprets medical information such as diseases or symptoms for a given visit in order to accurately assign and sequence the correct ICD 9 CM and CPT Codes with technical support to other departmental staff in identifying and resolving issues.
• Auditing Prior Authorisation according to coding guidelines and approve approve deny with the justification with the feedback for the Authorisation Team & preparing Audit saving reports on monthly basis.
• Uploading pricelist in MIMS, support other department like network & IT wherein coding knowledge is required for pricing or generation of new Application.
• Educate and Advise claims units on proper coding standards and billing rules, documentation, procedures and requirement and helping them in claim processing.
• Evaluate the documentation to ensure the data complexity and supports the reason for visit with legal standard and guidelines. Educate and advise claims units on proper coding standards and billing rules, documentation, procedures and requirements.
• Maintaining the provider database for Abu Dhabi and northern emirates providers with their respective pricelist and update the same on factor revision. In-depth analysis of provider pricelist within the grid and to prepare price proposal accordingly. Support network management through validation of services and prices.
• Ensure to justify with documents to support, and stand on coding related disputes with providers.
• Maintenance of Provider database across UAE as per the regular updates on status related to licensing, prices, factor revision & contact details with deletion and additions.
• Preparing provider contracts both SPC & SLA for all the facilities within the UAE as per the standard HAAD manuals and DHA Mandate.
Project handling: Inpatient coding, DRG coding, Emergency department and EM Coding.
•Coding in IR-DRG Diagnosis Related Grouping coding in 3 M software, CPT-4 and ICD-9-cm, ICD-10-Cm
•Medical coding audit on the hospital IP and OP Chart.
•Providing the coding support in claims processing before submitting to insurance.
•Participating in HAAD Coding Seminar.
•Implementation of HAAD guidelines and regulation in department.
•Working in the 3M software.
•Abstracts all necessary information from health records to identify secondary complication and Co-morbid conditions.
•Provides Feedback to doctors regarding coding errors or oversights.
•Provide Orientation to new doctors as per ICD-9-CM and CPT coding guidelines resulting in proficient clinical documentation.
•Prepare daily/monthly coding audit reports and submit to the management for statistics and data analysis.
•Submitting reimbursement claims to insurance companies
Providing Effective Training on Guidelines followed in ICD-9-CM, CPT Procedures and Basic Anatomy for the Trainees.
•Preparing question sets on various chapter on ICD-9-CM and CPT Procedures
Executive Claims
Bachelor of physiotherapy
Certified Professonal Coder
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