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
- Communicate with funders about clinical coding errors and disputes.
- Review of PMB queries and recommendations for action.
- Review of patient records for missing information.
- Comply with all legal requirements regarding clinical coding procedures and practices
- Adherence to Netcare policy and procedure and measurement of performance within the designated key performance area.
- 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.
- Clinical coding accuracy will be measured using reporting and trend analysis from the Netcare data analytics team
- 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.
- Actions that are guided by the South African Code of Ethics for Clinical Coders and South African coding standards
- Identify discrepancies, potential quality of care and billing issues.
- Valid driver’s licence and ability to travel.
- Excellent communication skills.
- CPT coding and an understanding of coding standards
- Ability to work extended hours.
- ICD 10 coding and an understanding of coding standards.
- Attention to detail.
- Multi-disciplinary clinical experience and knowledge of medical terminology.
Qualification & Experience:
- Certificate in Advanced ICD-10.
- Intermediate computer proficiency.
- Min of 3 years’ experience in Clinical Coding and or Case management in a hospital environment
- Certificate in Advanced Complete CPT for South Africa
- Diploma in Nursing or equivalent NQF level 6 qualification within healthcare sciences.
- SANC registration as a Registered Nurse.
Vacancy Type: Full Time
Job Functions: N/A
Job Location: Randburg, Gauteng, SA
Application Deadline: N/A