Clinical Coder

Overview

• SEHA Hospital Coder will competently navigate the patient health record and other computer systems/sources in the determination of appropriate diagnoses and procedures.
• Codes Routine Outpatient health records (utilizing encoder software and online tools and references in the assignment of codes).
• Consults reference materials to facilitate code assignment.
• Validates charges by comparing charges with health record documentation as necessary.
• Understands the appropriate link of diagnosis to procedure when applicable.
• Appends modifier(s) to procedure or service code when applicable.
• Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtained from the health record.
• Consults with CDI, physicians, or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous information.
• Collaborates with Revenue Cycle Management teams in resolving billing and utilization issues affecting reimbursement.
• Interprets bundling and unbundling guidelines (NCCI).
• Tracks issues (i.e., missing documentation or charges) that require follow-up to facilitate coding in a timely fashion.
• Investigates claims denials and/or appeals as directed.
• Consistently meets or exceeds coding quality and productivity standards established by Revenue Excellence.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Identifies concerns and is responsible for providing resolution of moderate to complex problems.
• Notifies appropriate leadership for resolution when appropriate.
• Performs other duties as assigned by Leadership.
• Maintains a working knowledge of applicable coding and reimbursement with UAE laws and regulations, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Assign ICD-10-CM and CPT codes to outpatient (OP)/emergency department (ED) medical records and captures charges for emergency department records;
• Adheres to official coding guidelines when coding with accuracy and completeness as supported by documentation;
• Interact with physicians and other areas when additional coding information is needed;
• Appropriately utilizes encoder and coding references;
• Assigns appropriate code(s) by utilizing coding guidelines established by UAE regulatory agencies;
• Utilizes ICD-CM Official Coding Guidelines for Coding and Reporting;
• Utilizes American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification;
• American Medical Association (AMA) CPT Assistant for CPT codes;
• American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Complying consistently with policies, procedures and practices and ensuring alignment with SEHA corporate policies
• Completing and maintaining regulatory requirements including: licensure and certification and other mandatory training within established time frames
• Maintaining confidentiality with regards to any information exchanged or received in the current capacity of role in accordance with SEHA corporate policies
• Assuming the role of a brand ambassador for SEHA and promoting a customer focused philosophy in dealing with any stakeholders
• Maintaining positive and effective working relationships within the department/division and also with other departments/sections within SEHA
• Performing any other duties as may be assigned relevant to the basic responsibilities of the role
• Adhering to requirements of the Occupational Health and safety guidelines and infection control guidelines
• Understanding and adhering to emergency preparedness plans/policies
• Recognizing the necessity of continuously developing skills and acquiring additional knowledge appropriate to the position
• Dressing appropriately to meet the expectations of the specific work area and in alignment with the Occupational Health and Safety policies
• Building key partnerships within the organization for pursuing client-centered, comprehensive, integrated systems of care
• Complying with any regulations related to mentoring, training, and development of UAE nationals staff