Clinical Coder

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.

Responsibilities

• 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
  

Qualifications

Required:

• BS in Health Information Management preferred
• Just have 1 of the following: o Coding Specialist (CCS)
  • Certified Coding Specialist – Physician-based (CCS-P)
  • Certified Professional Coder (CPC)
  • Certified Professional Coder – Hospital (CPC-H)
  • Certified Professional Coder – Payer (CPC-P)
• Extensive knowledge of healthcare revenue cycle systems;
• Ability to analyze physician/provider documentation contained in assigned Routine Outpatient (RO) health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses and any procedures;
• Ability to utilize encoder software applications, which includes all applicable online tools and references) in the assignment of ICD diagnosis and procedure codes.