Insurance Coordinator / Medical Coder
Job Summary:
The Insurance Coordinator/Medical Coder is responsible for managing all aspects of the medical insurance claims process. This includes accurate medical coding of diagnoses and procedures, submission of clean claims to insurance companies, and following up to ensure timely reimbursement.
Key Responsibilities:
- Claims Management: Prepare, review, and submit electronic and paper claims to various insurance companies (Daman, AXA, etc.) and government payers in compliance with DOH Abu Dhabi guidelines.
- Medical Coding: Accurately translate physician diagnoses and procedures into standardized codes using ICD-10 (diagnoses) and CPT/DRG (procedures) coding systems.
- Pre-Authorization: Obtain necessary pre-approvals and referrals from insurance companies for consultations, procedures, and medications.
- Follow-Up & Denial Management: Track submitted claims, investigate and resolve rejected or denied claims, and submit appeals when necessary.
- Patient & Provider Liaison: Act as the main contact for insurance-related queries from patients and clinic staff. Educate providers on coding and documentation requirements.
- Reporting: Generate reports on claims status, aging accounts receivable, and reimbursement rates.
Qualifications & Requirements:
- Certification in Medical Coding (e.g., CPC, CCS) is mandatory.
- Minimum 3 years of experience in medical insurance claims processing and coding within a UAE healthcare facility.
- Expert knowledge of DOH billing guidelines, ICD-10, CPT coding, and major insurance provider policies (especially Daman).
- Proficiency in medical billing software. Strong analytical and problem-solving skills.
- Fluency in English and Arabic.
