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Job Summary

The Medical and Dental Coder is responsible for reviewing clinical documentation and accurately assigning the appropriate diagnosis and procedure codes for medical and dental services. The role ensures that coding, documentation, insurance submissions, pre-approvals, and claims comply with applicable regulations, payer requirements, and internal policies.

Key Responsibilities1. Medical and Dental Coding

• Review patient medical and dental records and ensure that documentation supports the services provided.
• Assign accurate diagnosis and procedure codes based on the applicable coding standards and payer requirements.
• Ensure correct coding of medical, dental, laboratory, radiology, and other services provided by the facility.
• Verify that procedure codes are supported by the physician's or dentist's clinical documentation.
• Identify missing, incomplete, or inconsistent documentation and coordinate with the concerned healthcare professional for clarification.

2. Insurance Claims and Pre-Approvals

• Prepare and review insurance claims before submission.
• Submit and follow up on pre-authorization and pre-approval requests.
• Ensure that all required clinical documents, reports, X-rays, photographs, and supporting documents are attached when required.
• Monitor rejected and denied claims and identify the reasons for rejection.
• Coordinate with insurance companies and internal departments to resolve coding and documentation-related issues.
• Assist with claim resubmissions and appeals where applicable.

3. Compliance and Documentation

• Ensure coding practices comply with DOH regulations, insurance requirements, and facility policies.
• Maintain confidentiality of patient information and comply with data protection and medical record requirements.
• Ensure proper documentation for audits, inspections, and internal reviews.
• Identify coding errors and provide feedback to physicians, dentists, nurses, and other healthcare professionals.

4. Audit and Quality Improvement

• Conduct regular reviews and audits of medical and dental coding.
• Identify trends in claim rejections and recommend corrective actions.
• Support the implementation of corrective and preventive actions related to coding and documentation deficiencies.
• Assist in improving clinical documentation to support accurate coding and reimbursement.

5. Reporting

• Prepare regular reports on coding activities, claim rejections, denials, and pending approvals.
• Maintain records of submitted and resubmitted claims.
• Report recurring coding or documentation issues to management.

Qualifications and Requirements

• Diploma or Bachelor's Degree in a relevant healthcare, medical, dental, or health information field.
• Professional certification in medical coding is preferred.
• Experience in medical and/or dental coding, insurance claims, and pre-authorization processes.
• Good knowledge of medical and dental terminology.
• Knowledge of ICD, CPT, and other applicable coding systems.
• Knowledge of DOH requirements and UAE health insurance procedures is preferred.
• Experience with EMR systems and insurance portals is an advantage.
• Strong attention to detail and analytical skills.
• Good communication and coordination skills.
• Ability to maintain confidentiality and handle sensitive patient information.

Key Performance Indicators (KPIs)

• Coding accuracy rate.
• Number and value of claims rejected due to coding errors.
• Timely completion of coding and claim submissions.
• Reduction in claim denials and rejections.
• Timely submission and follow-up of pre-approvals.
• Compliance with documentation and coding requirements.
• Successful resolution of rejected and pending claims.

Working Relationships

The Medical and Dental Coder will work closely with:

• Doctors and Dentists
• Nurses and Clinical Staff
• Reception and Patient Coordinators
• Insurance and Revenue Cycle Team
• Medical Records Department
• Quality and Compliance Team
• Medical Center Management

Work Location: In person