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ROLE SUMMARY Under the direction of the Clinical Coding Specialist (CCS), an Intermediate Clinical Coder (ICC) will be responsible in collaboration with billings teams, for liaising between patients, treating clinicians and managed care organisations to provide accurate and complete coding on updates and claims. The ICC must take first responsibility for their development path and active enrolment onto the Advanced ICD-10 Coding Course with Netcare.The ICC must review and/or audit clinical documentation and resultant coding on patient files to ensure the accuracy and completeness of ICD-10 and CCSA coding as well as the sequencing of codes within the managed healthcare environment. The incumbent must ensure that the ICD-10 and CCSA coding assigned, provides an accurate reflection of the patient condition, clinical severity and medical necessity of treatment received.

The impact of coding on Alternative Reimbursement models/billing arrangements should be considered when assigning diagnostic and procedural codes. The position requires a high degree of collaboration and liaising between patients, treating clinicians, and managed care organisations to provide clinical coding that is updated in accordance with the patient response to treatment to receive reimbursement from funders. This will include escalations to relevant management at Administrators or Funders for resolution where necessary.

This position involves participation in system enhancement and process improvement projects and supporting the work needed to meet departmental, institutional and broader healthcare industry operational and strategic objectives. The incumbent will provide support, initiate and manage innovation and best practice, in response to ever-changing practices influencing efficiencies impacting on clinical coding.

They participate in clinical coding which is the backbone of risk management strategies such as Alternate Reimbursement Models (ARMs) and/or billing arrangements and Value Based Contracts (VBC). The accuracy and completeness of coding affects the Diagnostic Related Grouper (DRG), Major Diagnostic Category (MDC), case mix and therefore have a direct correlation to the related cost allocation of cases. Coding is critical for accurate billing and reimbursement of cases.

KEY WORK OUTPUT AND ACCOUNTABILITIES

DISRUPTIVE INNOVATION

Coding quality

Application of clinical and coding knowledge to accurately assign and sequence all ICD-10 and CCSA codes for services rendered for each patient event

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

Clinical coding completeness of all patient events relevant to medical history, diagnosis, treatment rendered, and procedures carried out and response to treatment.

Provide operational support for Billing Operation Clusters and hospitals with regards to the accuracy of ICD-10 and CCSA coding on claims

Engage with doctors and allied service providers to ensure complete and accurate ICD-10 and CCSA coding on each case is achieved

Audit patient events to assess accuracy and completeness of coding

Analyse medical records and identifies clinical documentation deficiencies

Utilize all available digital resources for accurate and appropriate clinical coding

Measure and report on hospital clinical coding compliance

Allocate clinical codes to patients’ current period of care using knowledge of the coding information contained on HCI and other relevant platforms

Continual assessment of work to ensure a continuous improvement in ICD-10 and CCSA coding and collection of quality health data

Review and analyse clinical coding periodically during a patient event in relation to mapped clinical coding requirements

Adherence to Netcare policy and procedure and measurement of performance within the designated key performance area

Compliance Management

Actions that are guided by the South African Code of Ethics for Clinical Coders and South African coding standards

Comply with all ethical and legal requirements regarding clinical coding and related practices

Conduct on-going audits and clinical coding reviews to ensure all clinical coding and clinical documentation is complete and precise

Clinical coding accuracy will be measured using reporting and trend analysis from the Netcare data analytics team

Rejection management

Review clinical coding periodically during a patient event in relation to coding requirements, to