Clinical Coder

Role Overview

Clinical Coder at SEHA Hospital. The role involves navigating patient health records and computer systems to determine and assign appropriate diagnosis and procedure codes for routine outpatient services.

Role Purpose

To competently analyze patient health records and clinical documentation, assign accurate ICD-10-CM and CPT codes to outpatient and emergency department records, validate charges against documentation, and collaborate with clinical and revenue cycle teams to ensure timely, compliant coding and appropriate reimbursement.

Key Responsibilities

Code Assignment & Documentation Analysis

• Analyze physician and provider documentation in routine outpatient, emergency department, and other assigned health records (electronic, paper, or hybrid) to determine principal diagnosis, secondary diagnoses, and procedures.
• Assign ICD-10-CM and CPT codes to outpatient and emergency department medical records with accuracy and completeness.
• Capture charges for emergency department records.
• Append modifiers to procedure or service codes when applicable.
• Interpret bundling and unbundling guidelines (NCCI).

Coding Standards & Compliance

• Adhere to official coding guidelines when coding, as supported by documentation.
• Assign appropriate codes utilizing coding guidelines established by UAE regulatory agencies.
• Utilize ICD-CM Official Coding Guidelines for Coding and Reporting.
• Utilize American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification.
• Utilize American Medical Association (AMA) CPT Assistant for CPT codes.
• Adhere to American Health Information Management Association (AHIMA) Standards of Ethical Coding.
• Maintain up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Maintain a working knowledge of applicable coding and reimbursement with UAE laws and regulations, as well as other policies and procedures.

Tools & References

• Utilize encoder software applications and all applicable online tools and references in the assignment of codes.
• Consult reference materials to facilitate code assignment.
• Appropriately utilize encoder and coding references.

Validation & Quality Assurance

• Validate charges by comparing charges with health record documentation as necessary.
• Understand the appropriate link of diagnosis to procedure when applicable.
• Utilize retrospective edit tool to address possible coding and documentation issues related to submitted diagnosis and procedure information obtained from the health record.
• Consistently meet or exceed coding quality and productivity standards established by Revenue Excellence.

Collaboration & Communication

• Consult with CDI, physicians, or other healthcare providers when additional information is needed for coding or to clarify conflicting or ambiguous information.
• Interact with physicians and other areas when additional coding information is needed.
• Collaborate with Revenue Cycle Management teams in resolving billing and utilization issues affecting reimbursement.
• Build key partnerships within the organization for pursuing client-centered, comprehensive, integrated systems of care.
• Maintain positive and effective working relationships within the department and division and with other departments and sections within SEHA.

Issue Management & Follow-up

• Track issues such as missing documentation or charges that require follow-up to facilitate coding in a timely fashion.
• Investigate claims denials and appeals as directed.
• Identify concerns and provide resolution of moderate to complex problems.
• Notify appropriate leadership for resolution when appropriate.

Organizational & Professional Standards

• Comply consistently with policies, procedures, and practices and ensure alignment with SEHA corporate policies.
• Ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Maintain confidentiality with regards to any information exchanged or received in accordance with SEHA corporate policies.
• Assume the role of a brand ambassador for SEHA and promote a customer-focused philosophy in dealing with stakeholders.
• Adhere to requirements of the Occupational Health and Safety guidelines and infection control guidelines.
• Understand and adhere to emergency preparedness plans and policies.
• Dress appropriately to meet the expectations of the specific work area and in alignment with Occupational Health and Safety policies.
• Complete and maintain regulatory requirements including licensure, certification, and other mandatory training within established time frames.
• Comply with any regulations related to mentoring, training, and development of UAE nationals staff.
• Recognize the necessity of continuously developing skills and acquiring additional knowledge appropriate to the position.
• Perform other duties as assigned by leadership.

Qualifications & Experience

• Bachelor of Science in Health Information Management preferred.
• Current certification in at least one of the following: Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder – Hospital (CPC-H), or Certified Professional Coder – Payer (CPC-P).
• Extensive knowledge of healthcare revenue cycle systems.
• Ability to analyze physician and provider documentation contained in assigned routine outpatient health records (electronic, paper, or hybrid) to determine the principal diagnosis, secondary diagnoses, and any procedures.
• Ability to utilize encoder software applications, including all applicable online tools and references, in the assignment of ICD diagnosis and procedure codes.

Skills & Competencies

• Proficiency with encoder software and online coding tools and references.
• Knowledge of ICD-10-CM and CPT coding systems.
• Understanding of diagnosis-to-procedure linkage requirements.
• Ability to interpret and apply bundling and unbundling guidelines (NCCI).
• Knowledge of AHA Coding Clinic, AMA CPT Assistant, and AHIMA Standards of Ethical Coding.
• Claims denial investigation and appeals management.
• Documentation analysis and interpretation.
• Problem-solving for moderate to complex coding issues.
• Communication and collaboration across clinical and administrative teams.
• Attention to detail and commitment to coding accuracy.