Clinical Coding Quality Assessor - DurbanFull job descriptionThe incumbent will be responsible in collaboration with hospital case management teams, for liaising between the patients, medical doctors and medical schemes 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 analyze 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 informationcontained 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.· Continual assessment of work to ensure a continuous improvement in ICD-10 and CPT coding and collection of quality health data.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· 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 ad hoc case management required at hospital level.Internal Customer Support· Provide support to the hospital billing department.· Assist with the training of staff regarding 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 regarding coding procedures. Serves as coding consultant to care providers.Job Type: Full-timeSalary: R25 000,00 - R30 000,00 per monthAbility to Relocate:Durban, KwaZulu-Natal: Relocate before starting work (Required)
