Qureos Mentor

GluCare.Health

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 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
 
 
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 Ensure precise CPT, ICD, and HCPCS coding for all outpatient encounters
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 Maintain zero tolerance for upcoding, undercoding, or unbundling.
 
 
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 Revenue Protection
 
 
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 Achieve less than 5 percent denial rate related to coding errors
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 Ensure submissions/resubmission are completed within payer timelines
 
 
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 Compliance
 
 
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 Maintain audit ready coding documentation
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 Ensure adherence to DHA regulations and UAE payer policies.
 
 
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 Core Responsibilities
 
 
 
 Clinical Coding
 
 
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 Review patient medical records, including physician notes, test results, charge tickets, and other documentation from outpatient encounters
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 Ensure coding reflects medical necessity and supports billed services
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 Clarify incomplete or ambiguous documentation with clinicians
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 Apply payer specific coding guidelines and bundling rules.
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 Assist with audits, denial management, education to providers on documentation best practices, and reimbursement questions
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 Submission of Clean claims to insurance within the defined TAT
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 Resubmission of partially rejected claims with justification within defined TAT time.
 
 
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 Denial Analysis and Resubmissions
 
 
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 Review rejected and denied claims to identify root causes
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 Correct coding errors and prepare compliant resubmissions;
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 Draft appeal letters with clinical justification and supporting documents, Track resubmission outcomes and escalate unresolved cases
 
 
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 Documentation Integrity
 
 
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 Ensure clinical notes, diagnostic reports, and orders support coded services
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 Validate alignment between coding, authorization, and billed services
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 Maintain organized digital records of denials, corrections, and appeals
 
 
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 Payer and TPA Coordination
 
 
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 Liaise with insurance companies and TPAs to clarify denial reasons
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 Communicate resubmission status to billing, approvals team, and management
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 Monitor payer policy updates and adjust coding practices accordingly
 
 
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 Systems and Reporting
 
 
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 Use HIS, EclaimLink, and payer portals to manage coding edits and resubmissions
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 Recommend process improvements to reduce recurring denials
 
 
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 Requirements
 
 
 
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 Certified Professional Coder credential
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 Bachelor's degree in Health Information Management, Nursing, or related field
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 Strong knowledge of DHA regulations and UAE payer rules
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 Minimum 2 years of coding and denial management experience in the UAE
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 Proficiency in EHR systems, coding tools, and Microsoft Office
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 Strong analytical skills and attention to detail
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 Effective communication with clinical, billing, and insurance teams
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 Experience in outpatient clinics or specialty centers, preferably endocrinology or metabolic care
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Medical Coder

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GluCare.Health

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Medical Coder