Medical Coder and Insurance Approval Officer

Job Role

The Medical Coder and Insurance Approval Officer at New Royal Medical and Dental Center (NRMDC) is responsible for reviewing clinical documentation, assigning accurate diagnostic and procedural codes, and managing the pre-approval, submission, and resubmission process with insurance companies and Third-Party Administrators (TPAs). The role ensures accurate, timely, and compliant coding and claims processing in line with UAE health authority regulations (MOHAP) and payer requirements, minimizing claim rejections and supporting the medical center's revenue cycle. This full-time role reports in person to the Insurance Head and the NRMDC Senior Management Team (SMT).

This job description is intended to convey information essential to understanding the scope of the role. It is not exhaustive and may be modified based on organizational needs.

Key Responsibilities

Medical Coding

• Review and interpret clinical documentation (diagnoses, procedures, treatments) from patient medical records for inpatient and outpatient encounters.
• Assign accurate ICD-10-CM, CPT, and HCPCS codes in accordance with national and payer-specific coding guidelines.
• Ensure appropriate selection of principal diagnosis, secondary diagnoses, and procedures relevant to reimbursement and clinical accuracy.
• Conduct physician queries where documentation is unclear or insufficient, to ensure the highest level of diagnostic specificity.
• Maintain up-to-date knowledge of coding guideline changes, DOH/DHA coding directives, and payer-specific requirements.
• Perform regular coding audits to identify errors, trends, and areas for improvement.
• Provide feedback and training support to physicians and clinical staff regarding documentation and coding accuracy.

Insurance Approval & Claims Management

• Evaluate and process pre-approval (prior authorization) requests for medical necessity based on clinical documentation and insurance policy terms.
• Submit approval requests to insurance companies/TPAs and follow up proactively to secure timely authorizations.
• Manage claim submission and resubmission processes, ensuring completeness and accuracy prior to dispatch.
• Investigate and resolve claim rejections and denials, coordinating with physicians, billing, and insurance companies to provide justification and required documentation.
• Track and monitor pending approvals, resubmissions, and outstanding claims to minimize delays and revenue leakage.
• Liaise directly with insurance companies and TPAs regarding approval status, rejected claims, and reconciliation.
• Maintain accurate records of all approvals, denials, and correspondence with payers.

Compliance & Reporting

• Ensure all coding and approval activities comply with UAE healthcare regulations (MOHAP) and payer contracts.
• Maintain strict patient confidentiality in line with data protection standards.
• Prepare daily, weekly, and monthly reports on coding productivity, approval turnaround times, rejection rates, and outstanding claims.
• Support internal and external audits related to coding and insurance claims.

Qualifications & Requirements

• Bachelor’s degree or Diploma in Health Information Management / Medical Coding / Healthcare Administration / Nursing / Allied Health.
• CPC certification (AAPC) preferred/mandatory.
• ICD-10-CM coding knowledge and certification/experience

Experience:

• Minimum 2–5 years of experience in medical coding and/or insurance pre-approval within a UAE healthcare or TPA/insurance setting.
• Prior experience with MOHAP coding standards and UAE payer systems is highly preferred.

Skills & Knowledge:

• Strong knowledge of medical terminology, anatomy, and physiology.
• Proficiency in ICD-10-CM, CPT, and HCPCS coding systems.
• Familiarity with UAE insurance claim management systems (Riyati and e-Claim).
• Strong understanding of UAE medical insurance processes, pre-approval procedures, and claims adjudication.
• Excellent attention to detail and analytical skills.
• Strong written and spoken English communication skills (Arabic is an advantage).
• Ability to work under pressure and meet productivity/quality targets.
• Proficient in MS Office and hospital information systems (HIS).

Pay: AED2,500.00 - AED3,500.00 per month

Work Location: In person