Specialist,DRG Case Management

Job Purpose:The jobholder will be responsible for managing inpatient cases as per defined TAT and ensuring accuracy of DRG codes submitted by Healthcare Providers.Jobholder must possess ability to deliver in a metric driven high pressure environment which functions in real time.Strong attention to detail; high degree of speed and adjudication accuracy.Strong proficiency in handling computer and software skills.

Job Responsibilities

Visit providers to manage inpatient cases, review DRG codes/severity levels submitted by healthcare facilities.Coordinate with physicians/providers efficiently& Ensure effective communication with provider.Negotiate cost with providers, ensure correct length of stay of inpatient cases and effective implementation of insurance protocol/DRG billing.Ensure all regulatory guidelines issued by the various regulatory bodies are adhered within day to day operations.Meet DRG Case Management defined targets;Meet 100% of assigned onsite visits to identify medical negligence, compromised member care and wastage . 100% compliance of ePAR process and guidelines.Ensure closure of case visit findings and accurate adjudication of ePAR cases.Prepare analytical reports of DRG cases and billing on a monthly basis.Additional Skills:Excellent coding skills; minimum five years of coding and IR-DRG and AP DRG experience.Knowledge of MS Office especially in MS-Excel.Knowledge of the full know-how of UAE insurance industry and regulatory environment. Interpersonal and influencing skills. Problem solving and decision making capabilities.Good command over English (Written, Spoken & Reading).Any Certifications in Medical Coding will be a key advantage.Ability to work under pressure and multitask in a highly dynamic environment.Good communication, negotiation, presentation and interpersonal skills.

Qualifications

Bachelor’s degree in medicine is mandatory (MBBS).Globally recognized qualification in coding skill.Insurance qualification/background is essential in similar role.Minimum working experience of 1-2 years in UAE in similar role.Candidate must have good exposure to IP case preapproval protocols.Candidate must possess local market know-how and must be well versed with regulatory guidelines.