BOC Clinical Coder at Netcare

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 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 SOCIETY

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 in Nursing or equivalent NQF level 4 qualification within healthcare sciences.
• Certified Intermediate ICD-10 Coder or completion of Netcare Intermediate Coing training
• Compulsory Enrolment into the Advanced ICD-10 Coding Course with Netcare
• SANC registration as an Enrolled Nurse or registration with an 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
• Intermediate computer proficiency

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

Deadline:2nd March,2026