Lead Coder Medical Records

We are looking for hard-working & adventurous allied Health who wish to advance their careers by joining overseas hospitals to gain international experience.

Summary

Reviews patient medical records for relevant diagnostic and procedure information and assigns corresponding codes according to standard coding guidelines maintaining productivity. Assists with the maintenance of various patient indexes and databases. Provides patient information retrieval assistance to researchers, finance and others as needed.

Education/Qualifications Required:

• Bachelor’s or Associate Degree/Diploma in Health Information Management, Hospital Administration, Health Allied field, or other related discipline is required.

Experience Post-Qualifications:

• Minimum Three (3) of related experience with Bachelor’s Degree, or minimum Five (5) years of related experience with Associate Degree/Diploma is required
• Completion of Hospital approved Coder Training Program
• Certified advanced level Clinical Coding Certificate (CCC) – preferred.

License:

• Current and in good Standing License/Registration to practice in country of residence

Job Duties and Responsibilities:

• Reviews patient medical records for all relevant diseases and assigns corresponding International Classification of Disease (ICD) codes according to standard coding guidelines.
• Utilizes, interprets and translates clinical documentation from the medical record into diagnostic and procedural codes; abstracts data into the coding software.
• Responsible for thoroughly knowing and utilizing all coding systems both inpatient and outpatient according to the most recent rules, regulations and conventions.
• Contacts physicians as necessary to request more complete information and/or clarification in order to completely code the patient records.
• Maintains an accurate and timely computerized database utilizing prescribed abstract format.
• Prepares or assists with the preparation of statistical or other special reports relating to patients, diseases and treatments.
• Performs audits, quality checks, provides training and educational sessions for Health Care Providers.
• Collaborates closely with the clinical documentation improvement team to enhance the documentation in the patient’s records to meet the criteria of high quality documentation.
• Performs statistical analysis, review Diagnosis Related Groups (DRGs), assists manager in reviewing patient’s case mix and identify trends.
• Participates in the training and education of coders as needed, and serve as a resource for expert opinion.
• Maintains coding skills and professional credentials with appropriate continuing education by reading and applying coding materials and policies.
• Oversees direct reports, including interviewing, selecting, training, motivating and evaluating.
• Follows all Hospital’s related Policies and Procedures.
• Participates in self and others’ education, training and development, as applicable.
• Performs other related duties as assigned.