Medical Insurance jobs

Job Summary

Responsible for accurately reviewing clinical documentation and assigning appropriate medical codes (diagnosis, procedure, and service codes) to ensure correct billing, timely insurance claim submission, and compliance with coding standards and payer requirements — directly supporting the hospital's revenue cycle and minimizing claim denials.

Key Responsibilities

• Review patient medical records, physician notes, and clinical documentation to assign accurate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS or local equivalent).
• Ensure coding accuracy and completeness in line with payer guidelines, MOH regulations, and insurance company requirements.
• Verify that documentation supports the codes assigned; query physicians for clarification when documentation is insufficient or ambiguous.
• Collaborate with billing staff to ensure claims are coded correctly before submission, reducing rejections and denials.
• Identify and correct coding errors, discrepancies, or missing information prior to claim submission.
• Stay updated on coding guideline changes, payer policy updates, and regulatory requirements (ICD-10 updates, CPT revisions, local MOH/insurance rules).
• Support denial management by reviewing coding-related denials and providing corrections or appeals documentation.
• Maintain coding productivity and accuracy targets/KPIs as set by the department.
• Ensure patient confidentiality and data security in line with HIPAA/local data protection standards.
• Participate in internal audits and coding compliance reviews.
• Coordinate with clinical departments and physicians to improve documentation quality (Clinical Documentation Improvement - CDI support).

Qualifications

• Diploma or Bachelor's degree in Health Information Management, Medical Coding, Nursing, or related medical field.
• Certified Medical Coder (e.g., CPC – Certified Professional Coder, CCS – Certified Coding Specialist, or equivalent) — required or strongly preferred.
• 2+ years of experience in medical coding, preferably in a hospital or multi-specialty setting.
• Strong knowledge of ICD-10, CPT/HCPCS coding systems, and payer-specific billing rules.
• Familiarity with Hospital Information Systems (HIS) and electronic health records (EHR).

Key Skills

• Strong attention to detail and accuracy
• Knowledge of medical terminology, anatomy, and clinical documentation standards
• Analytical and problem-solving skills
• Understanding of insurance claim requirements and denial reasons
• Good communication skills (to query physicians/clinical staff)
• Ability to work under deadlines and maintain productivity standards

Job Type: Full-time

Work Location: In person