HOSPITAL CLINICAL CODING SPECIALIST

SUMMARY:
HOSPITAL CLINICAL CODER

POSITION INFO:

My client is seeking a Clinical Coding specialist who will be responsible for liaising between the patients, treating clinicians and managed care organisations in order to provide clinical coding that is updated in accordance with the patient response to treatment in order to receive reimbursement from funders. The incumbent will assess clinical statements and convert this information into ICD 10 and CPT coding on the patient account.

Requirements:

• Diploma in Nursing or equivalent NQF level 6 qualification within healthcare sciences.
• Certificate in Advanced ICD-10.
• Certificate in Advanced Complete CPT for South Africa
• SANC registration as a Registered Nurse OR Enrolled Nurse
• Min of 3 years’ experience in Clinical Coding and or Case management in a hospital environment
• Intermediate computer proficiency.

 Knowledge of :

• CPT coding and an understanding of coding standards
• ICD 10 coding and an understanding of coding standards.
• Multi-disciplinary clinical experience and knowledge of medical terminology

Duties & Responsibilities

Managed Care Quality of coding

• Work with billing departments to achieve clinical coding excellence on all patient files.
• Application of clinical and coding knowledge to effectively assign and sequence all ICD 10 and CPT codes for services rendered for each patient event.
• Engage with all allied service providers to clarify information to ensure complete ICD 10 and CPT coding on each case is achieved.
• Allocate clinical codes to patients’ current period of care using knowledge of the information contained within the International Classification of Diseases, revision 10, and CPT coding books.
• Conduct assessment of work to make sure that it is continuous improvement in ICD-10 and CPT coding and collection of quality health data.
• Demonstrate expertise in clinical coding 
• Continual assessment of work to ensure a continuous improvement in ICD-10 and CPT coding and collection of quality health data.
• Review and analyse clinical coding periodically during a patient event in relation to mapped clinical coding requirements.
• Adherence to policy and procedure and measurement of performance within the designated key performance area.

Compliance Management

• Comply with all legal requirements regarding clinical coding procedures and practices
• Actions that are guided by the South African Code of Ethics for Clinical Coders and South African coding standards
• Clinical coding accuracy will be measured using reporting and trend analysis from the data analytics team
• Review of patient records for missing information.

Rejection management

• Review of PMB queries and recommendations for action.
• Communicate with funders about clinical coding errors and disputes.
• Identify discrepancies, potential quality of care and billing issues.

Utilisation Review

• Assist with adhoc case management required at hospital level.

Internal Customer Support

• Participate actively with the  data analytics team to iteratively improve on coding trends and rejection management.
• Provide support to the hospital billing department.
• Assist with the training of staff with regard to ICD-10 and CPT coding.

External Customer Support

• Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients with regard to coding procedures. Serves as coding consultant to care providers.

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