Specialist - Submission

Responsible for reviewing, abstracting and analyzing clinical information from medical records and relevant documents, translating the information into diagnostic and operative procedure codes in accordance with the clinical coding system.

• Reviewing and analyzing patient medical records to ensure all applicable patient data is available for coding 


• Abstracting pertinent information from patient records and assigning the relevant codes


• Assigning appropriate codes for pre-authorization purpose.


• Reviewing and assigning appropriate E&M’s codes based on Clinician’s documentation available in medical records, to ensure proper re-imbursement for the facility.


• Querying physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes


• Contacting the department/section or clinic and obtaining copies of additional documentation


• Ensuring accurate coding and sequencing as specified by established coding principles and guidelines, following the clinical coding system


• Allocating the appropriate and specific codes from the indexing system and assigning the codes for completing coding summary of the medical records


• Reviewing and auditing medical claims to ensure accuracy, compliance with payer guidelines, coding and billing standards, and organizational policies. This role involves identifying billing discrepancies, preventing revenue leakage, improving claim quality, and supporting continuous process improvement.


• Assisting with the preparation of medical records for the quality assurance and medical audit purposes by providing the coding data


• Validating that encoded information is reported with most accurate information Regulatory requirements 


• Timely analysis, notification and completion of medical records as per the facilities chart completion policies and procedures, regulatory and accreditation standards.


• Reporting defaulters to the Senior Clinical Coding Officer for further actions.as per the facilities policy and procedures.


• Reviewing and confirmation of assigned codes for resubmissions & denials for re-imbursement needs, pertaining to coding errors.


• Collaborate with coders, billers, physicians, and operational teams to resolve claim-related issues.


• Staying current with the clinical coding system through publications, seminars, workshops, continuing education programs and other changes in the insurance industry


• Ensuring that coding is consistent with all recognized standards


• Complying consistently with facility policies, procedures and practices and ensuring alignment with SEHA facilities policies


• Completing and maintaining regulatory requirements including: licensure and certification and other mandatory training within established time frames
  
   

Required:
Bachelor Degree in Health Information Management or relevant field with or Diploma with 3 years of additional experience in Healthcare

Desired:
Master degree or equivalent in Health Information Management or relevant field

Desired:
Diploma in relevant field