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Medical Coding Reviewer III
Company
Remotedxb
Location
dubai, dubai
Type
Full-time
Responsibilities
Support complex medical record audit programs, dispute management, and escalation management.
Generate in-depth reporting and analysis for Pre-Pay and Post-Paid processes to track performance.
Provide production and progress reports to management and recommend resolutions to increase team performance.
Mentor Program Integrity Audit Analysts and identify training opportunities to close knowledge gaps.
Use CPT, ICD10, HCPCS, DRG, and REV coding rules to analyze complex provider claim submissions.
Research and interpret state-specific Medicaid, federal Medicare, and ACA/Exchange laws and guidelines.
Make claim audit payment decisions for highly complicated scenarios using medical coding guidelines.
Refer suspected Fraud, Waste, or Abuse (FWA) to the Special Investigations Unit (SIU).
Collaborate with cross-departmental teams including Claims, Configuration, and IT to address system gaps...
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