Outpatient Coding Officer (Corniche Hospital)

Role Overview

Outpatient Coding Officer at SEHA, Corniche Hospital. The role is responsible for accurately reviewing patient health records and assigning appropriate diagnosis and procedure codes using coding software, reference materials, and established coding standards.

Role Purpose

Navigate patient health records and computer systems to determine appropriate diagnoses and procedures, assign accurate codes, validate charges, and ensure compliance with coding, billing, and reimbursement requirements.

Key Responsibilities

Coding & Code Assignment

• Assign ICD-10-CM and CPT codes to outpatient and emergency department medical records.
• Capture charges for emergency department records.
• Code routine outpatient health records utilizing encoder software and online tools and references.
• Adhere to official coding guidelines when coding with accuracy and completeness as supported by documentation.
• Assign appropriate codes by utilizing coding guidelines established by UAE regulatory agencies.
• Utilize ICD-CM Official Coding Guidelines for Coding and Reporting.
• Understand the appropriate link of diagnosis to procedure when applicable.
• Append modifiers to procedure or service codes when applicable.
• Interpret bundling and unbundling guidelines (NCCI).

Documentation & Information Management

• 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.
• Consult reference materials to facilitate code assignment.
• Consult with Clinical Documentation Improvement (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.
• Track issues such as missing documentation or charges that require follow-up to facilitate coding in a timely fashion.

Charge Validation & Quality Assurance

• Validate charges by comparing charges with health record documentation as necessary.
• 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.

Revenue Cycle & Billing Support

• Collaborate with Revenue Cycle Management teams in resolving billing and utilization issues affecting reimbursement.
• Investigate claims denials and appeals as directed.

Compliance & Professional Development

• Maintain a working knowledge of applicable coding and reimbursement with UAE laws and regulations, as well as other policies and procedures.
• Maintain up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Problem Resolution & Leadership

• Identify concerns and provide resolution of moderate to complex problems.
• Notify appropriate leadership for resolution when appropriate.
• Perform other duties as assigned by Leadership.

Qualifications & Experience

• CPC or AHIMA certification required.
• 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, which includes all applicable online tools and references, in the assignment of ICD diagnosis and procedure codes.

Skills & Competencies

• Proficiency with encoder software applications.
• Knowledge of ICD-10-CM coding standards.
• Knowledge of CPT coding standards.
• Familiarity with American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification.
• Familiarity with American Medical Association (AMA) CPT Assistant for CPT codes.
• Knowledge of American Health Information Management Association (AHIMA) Standards of Ethical Coding.
• Ability to navigate multiple computer systems and sources.
• Analytical and documentation review skills.
• Communication skills to interact with physicians and healthcare providers.
• Problem-solving ability for moderate to complex issues.