Insurance DRG Coder & RCM Analyst

Primary Responsibilities:

• 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.
• Analyze the healthcare revenue cycle from patient registration to final payment, identifying inefficiencies and opportunities for improvement.
• Monitor claims processing, payment posting, denials management, and accounts receivable.
• Investigate reasons for claim denials or delays and recommend corrective actions to reduce denials and accelerate cash flow.
• Collaborate with coding, billing, and clinical teams to ensure accurate and compliant charge capture.
• Generate and analyze reports on key performance indicators (KPIs) like days in accounts receivable, denial rates, and collection rates.
• Support implementation of new technologies or process improvements to optimize revenue cycle performance.
• Assist in training staff on best practices related to coding, billing, and revenue cycle processes.
• Ensure compliance with regulatory requirements impacting revenue cycle operations.
• Analyze clinical documentation to ensure completeness, accuracy, and compliance with coding standards and regulations.
• Ensure proper coding for inpatient stays to optimize reimbursement and reduce claim denials.
• Collaborate with physicians, clinical staff, and billing departments to clarify documentation discrepancies and improve coding accuracy.
• Stay updated with changes in coding regulations, payer guidelines, and compliance requirements.
• Conduct regular audits and quality checks to ensure coding accuracy and consistency.
• Assist in data reporting and provide insights on coding trends or patterns impacting revenue.
• Maintain knowledge of hospital billing and reimbursement processes related to DRG payments.

Job Requirements:

• Bachelor in Life Sciences
• Most relevant coding certification with updated membership to a body as accepted by the geographical governance area (AAPC or AHIMA).
• Relevant experience of at least 1 year in medical coding.
• Should at least have basic knowledge of Evaluation and Management services. Prior hands on experience would be an added advantage.
• Experience in UAE coding will be an added advantage.

Job Type: Full-time