Permanent
Gauteng, Pretoria
Posted 2 weeks ago

Together with our client in Pretoria, we are recruiting for a Lead Clinical Coding Specialist. The ideal candidate must have 10 years of coding experience and must hold a relevant clinical tertiary degree or diploma in nursing/pharmaceutical or medical field.

Duties:

  • Compile and maintain the client’s clinical coding strategy, including the mapping of various codes – PMB to RPL, RPL to CPT, linking NAPPI codes to ICD-10 codes.
  • Ensure that the client remains compliant with coding requirements for purposes of its accreditation.
  • Ensure that the client’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 the client’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 client at the 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 in 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 license.
  • 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 proficiency; and
    • Self-starter.

Remuneration:

  • R 65 000.00 – R 82 000.00 CTC per month
  • Retirement Annuity

Only candidates who meet all the minimum requirements stipulated in the advert, will be considered.

If you meet the above requirements, please send your CV with supporting documents to recruit@medicalresources.co.za

REF: Clinical Coding Specialist

Job Features

Job CategoryClinical Coding Specialist

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