Regional Clinical Coder

**Role summary**

Coding accuracy is a crucial component of consistency of care and to measure best and safest care for patients in Netcare. The Regional Clinical Coding Specialist will participate directly in the digital enablement through accurate clinical coding and make sure that the value of care billing is data driven.

The Regional Clinical Coding Specialist will take responsibility for the accuracy of ICD 10 and CSA coding within the managed care environment.

The incumbent will ensure that patients’ information is converted to ICD 10 and CCSA coding on the patient accounts and reflects the correct treatment path, clinical severity and patient condition through accuracy and completeness.

The incumbent will be responsible, in collaboration with Hospital Clinical Coder and 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. This will include escalations to relevant management at Administrators or Funders for resolution where necessary.

The incumbent will provide support, initiate and manage innovation and best practise, in response to ever-changing practises influencing efficiencies impacting on clinical coding.

**Key work output and accountabilities**

**OPERATIONAL EXCELLENCE**

**Quality of Coding**
- Application of clinical and coding knowledge to effectively assign and sequence all ICD 10 and CCSA codes for services rendered for each patient event.
- Clinical coding completeness of all patient events relevant to medical history, diagnosis, treatment rendered and procedures carried out and response to treatment.
- Application of clinical and coding knowledge to effectively assign and sequence all ICD 10 and CCSA codes for services rendered for each patient event.
- Analysis of medical records and identifies documentation deficiencies.
- Review clinical coding periodically during a patient event in relation to mapped coding requirements.
- Utilize all available digital resources for accurate and appropriate clinical coding.
- Engage with all doctors and allied service providers to ensure complete ICD 10 and CCSA coding on each case is achieved.
- Demonstrate expertise in clinical coding and the Diagnostic Related Grouper model and an understanding of the complex cause and effect factors within the broader managed care industry.
- Measure and report on hospital clinical coding compliance, discuss recommendations with management and ensure agreement of action plans.

**Compliance Management**
- Comply with all legal requirements regarding clinical coding procedures and practices.
- Conduct audits and clinical coding reviews to ensure all documentation is accurate and precise.
- Actions are guided by the South African Code of Ethics for Clinical Coders and South African coding standards.
- Monitor compliance with group policies, procedures and processes via CSA process.
- Manage the implementation of quality assurance systems to maintain high work standards and integrity of data reporting.

**Rejection Management**
- Analyse and design data exploitation systems to deliver information to business users, e.g. dashboards and information portals.
- Assist in identifying, interpreting and providing business intelligence systems to enable organisation wide decision making.
- Revise and amend systems and programs where corrections, system changes, improvements or database administration is required.
- Assessment and analysis of rejection reports to identify trends in clinical coding errors/queries.
- Communication with funders about clinical coding errors and disputes.
- Identifies discrepancies, potential quality of care and billing issues.
- Review of PMB queries and recommendations for action.

**GROWING WITH PASSIONATE PEOPLE**

**Internal Customer Support**
- Ensure that statistical data is available and reported for area of responsibility.
- Participate actively with the Netcare data analytics team to iteratively improve on coding trends and rejection management.
- Assist, lead or supervise in orienting, training and monitoring staff.

**External Customer Support**
- Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients with regard to clinical coding procedures. Serves as clinical coding consultant to care providers.

**Personal and Professional Development**
- Develop collaborative relationships to help accomplish work goals.
- Support of National initiatives and assist in responding to the changing business needs and development within Netcare.
- Active involvement in own professional development to maintain a satisfactory level of skill and knowledge.

**Skills profile**

**Education**

**Essential**
- Diploma in Nursing or equivalent NQF level 6 within healthcare sciences.
- Certificate in Advanced ICD-10.
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