Billing Operations Centre BOC Clinical Coder at Netcare

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
• Analyze 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 analyze 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 practice
• 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 decrease or eradicate coding errors, reduce short payments, claims rejections

Communicate with funders about clinical coding errors and disputes       

• Identify discrepancies, potential quality of care and billing issues
• Review of PMB and other coding related queries and recommendations for action

Internal Customer Support

• Participate actively with the Netcare data analytics team to iteratively improve on coding trends and rejection management
• Serves as a subject matter expert to case managers and internal and external stakeholders
• Mentor and coach staff on coding related matters
• Provide coding support to the hospital billing department
• Assist with the training of staff on relevant diagnostic and procedural coding schemas

External Customer Support

• Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients regarding to coding procedures.
• Serves as coding consultant to care providers

TRANSFORMATION OF OUR SOCIET

Build and maintain stakeholder relationships

• Develop collaborative relationships to help accomplish work goal.
• Maintain customer intimacy through building relationships with billings teams, doctors, nursing staff and other relevant internal and external stakeholders.
• Build strategic inter-departmental relationships to help achieve business goals at Exco and departmental level within the hospitals and BOCs.
• Foster an effective working relationship with staff and internal and external stakeholders.

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 or degree in Nursing or equivalent NQF level 6 qualification within healthcare sciences
• Certificate in Advanced ICD-10 or completion of Netcare Advanced ICD-10 training
• SANC registration as a Registered Nurse or equivalent professional body

Preferred

• Completed a CCSA (Complete CPT® for South Africa) coding course or completion of Netcare Discipline specific CCSA coding training

WORK EXPERIENCE

Essential

• Min of 3 years’ experience in Clinical Coding and or Case management in a hospital environment

KNOWLEDGE

Essential

• CCSA coding and an understanding of coding standards
• ICD-10 coding and an understanding of coding standards
• Multi-disciplinary clinical experience and knowledge of medical terminology
• Excellent communication skills
• Attention to detail
• Ability to work extended hours
• Anatomy and physiology
• Intermediate computer proficiency