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.

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.

Navigate patient health records and other systems to determine appropriate diagnoses and procedures; code Routine Outpatient health records using encoder software and online references; consult reference materials to facilitate code assignment; validate charges by comparing charges with health record documentation; understand linking of diagnosis to procedure when applicable; append modifiers to procedure or service codes when applicable; use retrospective edit tool to address coding/documentation issues; consult with CDI, physicians, or other providers for additional information; collaborate with Revenue Cycle Management on billing and utilization issues; interpret bundling/unbundling guidelines (NCCI); track issues requiring follow-up to facilitate timely coding; investigate claims denials and/or appeals as directed; maintain up-to-date knowledge of coding/reimbursement guidelines and regulations; resolve moderate to complex problems and notify leadership when appropriate; perform other duties as assigned; maintain knowledge of UAE laws/regulations related to coding and reimbursement.