وصف الوظيفة
Role Overview
OP Medical Coder at NMC Healthcare. Under general supervision, the Medical Coder is responsible for abstracting and assigning codes for diagnoses and procedures to both inpatient and outpatient healthcare records with accuracy, and serving as a coding resource to staff.
Role Purpose
Abstract and assign accurate diagnosis and procedure codes across inpatient, outpatient, day case, and observation records. Serve as the primary coding resource to clinical and billing staff, support revenue optimization through precise coding, and ensure compliance with accreditation and regulatory standards.
Key Responsibilities
Clinical Coding
- Code outpatient claims by assigning appropriate E&M, CPT, ICD and USCLS codes.
- Code inpatient claims to derive the most appropriate DRG codes and severity levels.
- Code all day cases and observations with relevant ICD, CPT, HCPCS and service codes.
- Code all inpatient and outpatient approval requests.
- Re-evaluate cases at resubmission to add, delete, or change codes according to available documentation in order to justify performed services.
- Clarify ambiguities and highlight inconsistencies in diagnoses described in medical records to physicians with escalation to the Head of Department.
- Document all clarifications provided.
Staff Support and Training
- Provide orientation to new doctors and nursing staff regarding documentation of cases in patient and medical records.
- Assist doctors with codes to help them document cases in the most appropriate manner and include all essential requirements.
- Address all coding queries from the billing, laboratory, and radiology departments.
Billing and Revenue
- Provide coding assistance to the insurance billing team as required.
- Achieve accuracy in coding to attain maximum revenue.
Audit and Compliance
- Prepare the facility for coding audits for accreditation.
- Implement all mandates set by the Department of Health and CCSC.
- Assist auditors during insurance audits.
- Help the insurance manager prepare feedback and reports from audits.
Record Management and Follow-up
- Follow up with doctors regarding incomplete medical record files to ensure completion.
Reporting and Data Management
- Maintain statistical data regarding coding.
- Present statistical data to the Head of Department and management as requested.
Standards and Protocol
- Adhere to the hospital's telephone standards.
Qualifications & Experience
- Bachelor degree (preferably with medical background).
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