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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.
