Medical Coding Specialist

Function:

Compile and maintain the Companys clinical coding strategy, including the mapping of various codes – PMB to RPL, RPL to CPT, linking NAPPI codes to ICD-10 codes.

Ensure that Company remains compliant with coding requirements for purposes of its accreditation.

Ensure that Company’s systems are updated with the latest versions of applicable codes (MIT, PMB, CPT, ICD, etc.)

Compile business requirement documents and system specifications for IT to ensure coding is applied correctly.

Update Company’s coding to ensure the Scheme remains up to date with industry developments.

Engage with other internal and external role players where expertise is required on coding, e.g. benefit design, and extract codes from the system to assist Risk in costing thereof.

Analyse and recommend alternative codes or reimbursement models that will benefit the Company.

Represent the Company at industry level on various coding related platforms, e.g. CMS, PHISC and NAB.

Identify coding touchpoints with existing systems within the Company, e.g. claims processing, CAM and PBM, to ensure the coding strategy is applied correctly in various systems.

Assist with queries by the CMS and service providers regarding the correct application of codes.

Participate in discussions with provider groupings regarding alternative coding structures and the impact thereof on the Company.

Ensure constant operational efficiency through innovation within areas under control. Ensure adherence to all legislative and regulatory prescripts.

Requirements:

A relevant clinical tertiary degree or diploma in nursing or the pharmaceutical or medical field.

At least 10 years experience of coding.

Knowledge of the following: - Clinical coding; - Clinical, medical and procedural terminology; - The Medical Schemes Act; and - RPL and MDCM.

Computer literate in MS Word, Excel and PowerPoint.

Must possess a valid K53 driving licence.

Must possess the following skills: - Verbal and written communication skills; - Negotiation skills; - Presentation skills; - Advanced analytical skills; - Delivering results; - Continuous improvement; - Cross-functional interaction; - Technology proficient; and - Self-starter