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.