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