Insurance coordinator (Pharmacy)

Job Overview

The Insurance coordinator (Pharmacy) will be responsible for claim submission and resubmission related services by accurately coding procedures in compliance with UAE insurance and regulatory guidelines. The ideal candidate will ensure proper submission of claims, reduce rejections, and maximize revenue cycle efficiency in coordination with physicians, billing, and insurance teams.

Job Responsibilities

• Ensure 100% claim submission and re-submission at all the pharmacy business entities within the agreed time frame.
• Review outpatient clinical documentation and assign accurate CPT, ICD-10, and HCPCS codes.
• Validate insurance approvals, coverage policies, and coding requirements before claim submission.
• Cross-check diagnosis and procedure code with physician documentation for consistency.
• Collaborate with the concerned teams to clarify diagnoses or obtain missing information.
• Support the billing team in resolving claim rejections or denials due to coding discrepancies.
• Keep updated with insurance guidelines, coding rule changes, and payer-specific circulars.
• Generate coding-related audit reports to ensure documentation and billing accuracy.
• Assist in internal and external audits, including compliance checks and pre-insurance assessments.
• Participate in ongoing training sessions and contribute to improving coding workflows
• Ensure proper documentation for the entire process.
• Ensure coding accuracy and compliance with DHA/MOH/DOH regulations and payer- specific requirements
• Complete special tasks assigned by the Reporting Manager.

Qualification & Experience

• Bachelor’s Degree in a medical or healthcare-related field.
• Minimum 3–5 years of UAE experience in medical coding, Pharmacy Claim submission, re-submission, and reconciliation.
• Familiarity with DHA/MOH/DOH insurance regulations and payer portals (e.g., eClaimLink,
• Riayati, Shafafiya).
• Certified Professional Coder (CPC) or equivalent certification (AAPC/AHIMA recognized).
• Strong interpersonal and communication skills
• Sound knowledge of CPT, ICD-10, and HCPCS coding systems.
• Proficient in Microsoft Office and EMR/HIS systems.