Clinical Coding accuracy is a crucial component of consistency of care and to measure best and safest care for patients.
The incumbent will be responsible in collaboration with hospital case management teams, 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.
The account will reflect the correct treatment path, clinical severity and patient condition through accuracy and completeness of coding.
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.
Read and analyse records from all available digital and other resources for accurate and appropriate coding that reflects the relevant medical history and care the patient received as well as the response to treatment.
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 and the DRG model and an understanding of the complex cause and effect factors within the broader managed care industry.
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.
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
Review of patient records for missing information.
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.
Assist with adhoc case management required at hospital level.
Internal Customer Support
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.
Diploma in Nursing or equivalent NQF level 6 qualification within healthcare sciences. Certificate in Advanced ICD-10.
SANC registration as a Registered Nurse.Preferred
Certificate in Advanced Complete CPT for South Africa
Min of 3 years’ experience in Clinical Coding and or Case management in a hospital environment Intermediate computer proficiency