Specialist,DRG Case Management

Sukoon Workplace Savings Solutions Limited; Dubai; Sur place; AED 167 000 - 257 000; Plein temps

Résumé du poste

Sukoon Workplace Savings Solutions Limited is conducting a DRG coding and inpatient case management role in the UAE. The successful candidate will review DRG codes, manage case severity levels, and coordinate with physicians and providers to ensure accurate DRG billing in line with insurance protocols.

The role requires excellent coding skills with 5+ years of DRG experience, strong English communication, and the ability to work under pressure in a dynamic UAE environment.

Qualifications

• Bachelor’s degree in medicine (MBBS) mandatory.
• Globally recognized coding qualification desirable.
• Insurance qualification/background essential in similar role.

Responsabilités

• Visit providers to manage inpatient cases; review DRG codes/severity levels.
• Coordinate with physicians/providers; ensure effective communication with providers.
• Negotiate costs with providers; ensure correct length of stay and DRG billing per insurance protocol.
• Ensure compliance with regulatory guidelines issued by regulatory bodies.
• Meet DRG Case Management targets; achieve 100% onsite visit compliance and ePAR adherence.
• Close case visit findings and adjudicate ePAR cases accurately.
• Prepare monthly analytical reports of DRG cases and billing.

Connaissances

Medical coding

IR-DRG

AP DRG

English proficiency

Formation

MBBS

Coding certification

Insurance qualification

Outils

MS Excel

Description du poste

• 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.