Qureos Mentor

Quironsalud

Primary Responsibilities:<ul><li>Review inpatient medical records to accurately assign diagnosis-related groups (DRGs) and procedure codes based on ICD-10-CM, ICD-10-PCS, and CPT coding guidelines.</li><li>Analyze the healthcare revenue cycle from patient registration to final payment, identifying inefficiencies and opportunities for improvement.</li><li>Monitor claims processing, payment posting, denials management, and accounts receivable.</li><li>Investigate reasons for claim denials or delays and recommend corrective actions to reduce denials and accelerate cash flow.</li><li>Collaborate with coding, billing, and clinical teams to ensure accurate and compliant charge capture.</li><li>Generate and analyze reports on key performance indicators (KPIs) like days in accounts receivable, denial rates, and collection rates.</li><li>Support implementation of new technologies or process improvements to optimize revenue cycle performance.</li><li>Assist in training staff on best practices related to coding, billing, and revenue cycle processes.</li><li>Ensure compliance with regulatory requirements impacting revenue cycle operations.</li><li>Analyze clinical documentation to ensure completeness, accuracy, and compliance with coding standards and regulations.</li><li>Ensure proper coding for inpatient stays to optimize reimbursement and reduce claim denials.</li><li>Collaborate with physicians, clinical staff, and billing departments to clarify documentation discrepancies and improve coding accuracy.</li><li>Stay updated with changes in coding regulations, payer guidelines, and compliance requirements.</li><li>Conduct regular audits and quality checks to ensure coding accuracy and consistency.</li><li>Assist in data reporting and provide insights on coding trends or patterns impacting revenue.</li><li>Maintain knowledge of hospital billing and reimbursement processes related to DRG payments.</li></ul>Job Requirements:<ul><li>Bachelor in Life Sciences</li><li>Most relevant coding certification with updated membership to a body as accepted by the geographical governance area (AAPC or AHIMA).</li><li>Relevant experience of at least 1 year in medical coding.</li><li>Should at least have basic knowledge of Evaluation and Management services. Prior hands on experience would be an added advantage.</li><li>Experience in UAE coding will be an added advantage.</li></ul>Job Type: Full-time

Insurance DRG Coder & RCM Analyst

Job Title: Healthcare Quality ManagerJob Summary:The Healthcare Quality Manager is responsible for leading quality improvement, patient safety, and accreditation readiness initiatives across the healthcare facility in alignment with UAE regulatory standards, including those from the Department of Health (DOH), Dubai Health Authority (DHA), and MOHAP. This role ensures compliance, fosters a culture of continuous improvement, and enhances clinical and operational performance to ensure safe, high-quality patient care.Key Responsibilities:<ul><li>Develop and implement healthcare quality policies and patient safety programs in accordance with UAE national standards (e.g., JCI, DOH, DHA, MOHAP).</li><li>Monitor clinical indicators, patient safety metrics, and incident reporting systems; analyze data for trends and opportunities for improvement.</li><li>Coordinate internal and external audits, risk assessments, and regulatory inspections.</li><li>Lead and support accreditation processes (e.g., Joint Commission International, ISO, or local UAE accreditations).</li><li>Facilitate root cause analyses (RCA), failure mode and effect analysis (FMEA), and performance improvement (PI) projects.</li><li>Train and educate staff on quality improvement methodologies, patient safety, and regulatory standards.</li><li>Collaborate with clinical and non-clinical departments to ensure policies, procedures, and practices meet quality standards.</li><li>Prepare regular quality reports for senior management and regulatory authorities.</li><li>Serve as the primary point of contact for quality-related issues with UAE health authorities.</li></ul>Qualifications:<ul><li>Education: Bachelor&rsquo;s degree in Nursing, Healthcare Administration, Public Health, or a related field (Master&rsquo;s degree preferred).</li><li>Experience: Minimum of 5 years in healthcare quality management or a similar role within a hospital or healthcare facility.</li><li>Certifications:</li><li>Certified Professional in Healthcare Quality (CPHQ) &ndash; preferred or required.</li><li>Knowledge of JCI, ISO, and UAE-specific healthcare regulatory frameworks.</li></ul>Skills and Competencies:<ul><li>Strong knowledge of UAE healthcare regulations (DOH, DHA, MOHAP).</li><li>Experience in managing accreditation cycles (especially JCI).</li><li>Analytical and data interpretation skills, with proficiency in dashboards and KPIs.</li><li>Effective leadership, team management, and communication skills.</li><li>Fluent in English (Arabic is an advantage).</li></ul>Work Environment:<ul><li>Based in a hospital in the UAE.</li><li>Office-based role with regular engagement across departments.</li></ul>Job Type: Full-time

Healthcare Quality Manager

Primary Responsibilities:<ul><li>Must have appropriate DRG knowledge and experience</li><li>The Coder must undertake a thorough review of applicable documentation to assess the documentation requirement and determine the appropriate ICD-10-CM and/or CPT-4/codes to be reported, in conjunction with the applicable version of Official Guidelines.</li><li>Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered.</li><li>Understand the individual client payer contracts so as be able to process claims in submission.</li><li>Be able to process claims either in OP or IP scenario</li><li>Analyze and communicate coding and billing issue of the provider to the supervisors.</li><li>Have complete knowledge of Coding &amp; billing guidelines of the provider and payer.</li><li>Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.</li><li>To assist with documentation review and raise queries on completeness of EMR</li><li>Must also observe UAE code of ethics while assigning relevant code sets.</li><li>Preapproval and Precertification for claims requiring approval.</li><li>Making Cost estimates according to procedures</li><li>Monitoring and follow up on prior authorization for outpatient/inpatient services</li><li>Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer</li><li>Contacting the payers/TPA for approval related matters. Communicates adequately with external parties.</li><li>Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.</li><li>Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution</li><li>Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate</li><li>Timely and meets deadlines.</li><li>Reporting trends related to preapproval to reporting TL /Supervisor</li></ul>Job Requirements:<ul><li>Bachelor in Life Sciences</li><li>Most relevant coding certification with updated membership to a body as accepted by the geographical governance area (AAPC or AHIMA).</li><li>Relevant experience of at least 1 year in medical coding.</li><li>Should at least have basic knowledge of Evaluation and Management services. Prior hands on experience would be an added advantage.</li><li>Experience in UAE coding will be an added advantage.</li></ul>Job Type: Full-time

Senior Insurance DRG Coder

Join Quironsalud and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Quironsalud

ABOUT_COMPANY

Insurance DRG Coder & RCM Analyst

Healthcare Quality Manager

Senior Insurance DRG Coder