CPC Medical Coder – NPHIES Denial Management; Hospital & Specialty Coding
Listed on 2026-01-22
-
Healthcare
Medical Billing and Coding, Healthcare Administration, Medical Records, Healthcare Management
Location: Saudi Arabia (Riyadh/Egypt/ Remote – as applicable)
Employment Type: Full-time
Department: Revenue Cycle Management / Coding & Claims
Reports to: Coding Supervisor / Denial Management Lead / RCM Manager
Job Summary
Looking for exciting career opportunities in the healthcare revenue cycle management (RCM) field? Shah Manar is partnering with a leading RCM solutions provider to source exceptional talent for their expanding team in Saudi Arabia
.
We are recruiting professionals across multiple roles to support operational excellence, client success, and world-class revenue cycle services. If you’re driven, experienced, and ready to take the next step in your healthcare career, we want to hear from you!
We are seeking a highly skilled and detail-oriented CPC Certified Medical Coder with strong expertise in Saudi insurance claim workflows, including NPHIES, to support hospital and specialty coding operations. This role will focus on accurate clinical coding, denial analysis, and claims correction to improve the hospital’s clean claim rate, reduce rejections/denials, and ensure compliance with CCHI and payer-specific guidelines.
The ideal candidate has experience coding across specialties and working closely with RCM and clinical teams to resolve documentation gaps and payer compliance issues.
Key Responsibilities- Assign accurate coding for inpatient and outpatient cases:
- ICD-10 diagnosis coding
- CPT / HCPCS procedure coding
- Proper use of modifiers
- Ensure coding accuracy for hospital services such as:
- Emergency Department (ER)
- Outpatient clinics
- Day surgery / OR coding
- Inpatient admissions (if applicable)
- Apply payer coding rules for bundling, unbundling, and medical necessity.
- Support the end-to-end claims process within NPHIES
, including: - Eligibility verification alignment
- Authorization and service mapping compliance
- Claim submission readiness
- Rejection and denial resolution
- Ensure accuracy of coding and documentation per:
- NPHIES claim rules
- Saudi insurer requirements
- Provider contract rules and coverage limitations
- Coordinate with billing/RCM teams for claim corrections and resubmissions.
- Review and analyze denials related to coding, documentation, and medical necessity.
- Identify denial trends such as:
- Incorrect code selection
- Missing modifiers
- Unapproved services vs authorization
- Diagnosis/procedure mismatch
- Bundling/NCCI-related edits
- Duplicate claims / non-covered services
- Recommend corrective actions and prevent recurrence through coding fixes and provider education.
- Support appeals and claim resubmissions by providing correct coding and documentation guidance.
- Ensure compliance with:
- CCHI regulations
- Saudi payer policies (Bupa, Tawuniya, Medgulf, Allianz, etc.)
- Internal coding quality standards
- Perform coding audits and support quality improvement initiatives.
- Query providers when documentation is unclear or missing, ensuring coding is supported.
- Maintain strict confidentiality and adhere to hospital compliance policies.
- Active CPC Certification (AAPC) required.
- Minimum 3+ years of medical coding experience
, preferably in hospital or specialty coding. - Strong knowledge of:
- ICD-10
- CPT / HCPCS
- E/M coding guidelines
- Modifiers, medical necessity, payer edits, and compliance standards
- Strong understanding of claim rejection and denial workflows.
- Experience working with hospital documentation and coding systems.
- Experience with NPHIES claims, rejections, and denial resolution
- Hospital coding experience (ER, outpatient, inpatient, OR coding)
- Specialty coding expertise in one or more areas:
- Cardiology, Orthopedics, General Surgery
- OB/GYN, Dermatology, ENT
- Gastroenterology, Neurology
- Oncology, Radiology, Anesthesia
- Experience with Saudi payer portals and claim policies.
- Knowledge of DRG coding (if applicable) or facility coding frameworks.
Preferred: Arabic & English
- Arabic: Ability to coordinate with providers and hospital departments
- English: Required to interpret medical documentation, coding resources, and payer policy notes
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