Medical Coder

Role Overview

The Medical Coder should ensure accurate clinical coding and timely claim submissions/resubmission. You protect revenue by reducing coding errors, preventing denials, and securing appropriate reimbursement. You ensure compliance with DHA regulations and payer requirements.

Key Objectives 

Operational Accuracy

• Ensure precise CPT, ICD, and HCPCS coding for all outpatient encounters.
• Maintain zero tolerance for upcoding, undercoding, or unbundling. 

Revenue Protection

• Achieve less than 5 percent denial rate related to coding errors.
• Ensure submissions/resubmission are completed within payer timelines.

 Compliance

• Maintain audit ready coding documentation.
• Ensure adherence to DHA regulations and UAE payer policies. 

Core Responsibilities

 Clinical Coding

• Review patient medical records, including physician notes, test results, charge tickets, and other documentation from outpatient encounters.
• Ensure coding reflects medical necessity and supports billed services.
• Clarify incomplete or ambiguous documentation with clinicians.
• Apply payer specific coding guidelines and bundling rules. 
• Assist with audits, denial management, education to providers on documentation best practices, and reimbursement questions.
• Submission of Clean claims to insurance within the defined TAT.
• Resubmission of partially rejected claims with justification within defined TAT time. 

Denial Analysis and Resubmissions

• Review rejected and denied claims to identify root causes.
• Correct coding errors and prepare compliant resubmissions; • Draft appeal letters with clinical justification and supporting documents, Track resubmission outcomes and escalate unresolved cases.

 Documentation Integrity

• Ensure clinical notes, diagnostic reports, and orders support coded services.
• Validate alignment between coding, authorization, and billed services.
• Maintain organized digital records of denials, corrections, and appeals.

 Payer and TPA Coordination

• Liaise with insurance companies and TPAs to clarify denial reasons.
• Communicate resubmission status to billing, approvals team, and management.
• Monitor payer policy updates and adjust coding practices accordingly.

 Systems and Reporting

• Use HIS, EclaimLink, and payer portals to manage coding edits and resubmissions.
• Recommend process improvements to reduce recurring denials.

Requirements

• Certified Professional Coder credential.
• Bachelor’s degree in Health Information Management, Nursing, or related field.
• Strong knowledge of DHA regulations and UAE payer rules.
• Minimum 2 years of coding and denial management experience in the UAE.
• Proficiency in EHR systems, coding tools, and Microsoft Office.
• Strong analytical skills and attention to detail.
• Effective communication with clinical, billing, and insurance teams.
• Experience in outpatient clinics or specialty centers, preferably endocrinology or metabolic care.