Medical Coding

The Medical Coder is mainly responsible for assigning codes to diagnoses and procedures, using ICD

(International Classification of Diseases) and CPT (Current Procedural Terminology) codes. Ensures codes

are accurate and sequenced correctly in accordance with government and insurance regulations. Follows

up with the provider on any documentation that is insufficient or unclear. Communicates with other clinical

staff regarding documentation. Searches for information in cases where the coding is complex or unusual.

Receives and reviews patient charts and documents for accuracy. Ensures that all codes are current and active

Key result areas

• Deliver role's results within or exceeding SLA's
• Provide effective customer service
• Complete before/after work reports
• Actively support projects
• Apply work process standards and specifications effectively and efficiently
• Develop and manage effective work plans and priorities
• Adhere to company policies and procedures
• Serve as an effective ambassador of employer reputation
• Act as an effective team player
• Contribute to effective cross-functional teamwork
• Maintain effective customer relations
• Build capability in own area of work
• Share and develop knowledge effectively
• Contribute new ideas for service or process improvement/innovation

Key responsibilities

Functional:

• Understand the company's business model, its core operations, products and services; work to

understand the business priorities of internal and external clients

• Demonstrate some advanced functions of at least one core application; perform first-level problem

resolution before seeking help elsewhere; help colleagues with desktop tools when necessary

• Identify concepts related to medicine and health care in both the Philippine and US Setting; summarize

clinical information based on clinical indication of patient, using only pertinent clinical information;

state which resources to seek guidance, if needed manuals, on-line help, help desk, or tutorial

facilities; learn and apply new concepts quickly and be willing to expand job knowledge

• Gather information from a variety of sources and initiate plan of action; analyze data with a keen sense

for what is useful; identify sources of data and learn where to find the most relevant information for

solving problems

• Produce factual, clear and accurate documentation; follow defined procedures to document all routine

information; maintain documentation and records in a secure and confidential manner; demonstrate

awareness of the principles of HIPAA and DPA and how it relates to documentation practices;

demonstrate awareness on who can access the information

• Understand the importance of accuracy in own function or unit; identify tasks or outputs that require

accuracy and detail-level attention; describe consequences of errors within own unit or function; follow

the procedures for making sure that results are mistake-free; learn from mistakes

Core:

• Convey (verbal & written) standard messages in a clear and coherent manner, while maintaining

correctness in grammar and pronunciation

• Respond correctly to client needs in a timely and professional manner, regardless of client attitude;

strive to consistently meet service standards

• Track and monitor goals and activities versus results using standard tools (i.e., Task/Activity List,

Monitoring of Action Plan); initiate action to correct quality problems or notify others of quality issues,

as appropriate

• Adapt to and support changes in the workplace; challenge the usual way of doing things in a professional

manner and suggest ways to improve them

• Respond to collaboration with others and assist them in the delivery of their work, when needed; openly

share information and seek others' input and feedback in a professional manner

• Understand basic principles and can cite examples of proper and improper business behavior;

recognize ethical requirements within own area of responsibility; deal with business situations that

involve ethical issues; describe key issues covered by organization's code of ethical conduct

• Works with Operations and Program Manager and Team Leader and provides regular provision of information to

decision makers in the organization to support them in their work.

• Collaboration with Tier II QA Associate, Quality Assurance Specialist and Training Specialist on the development of

new processes, tools, services that otherwise could not have been done by individuals.

Qualifications and skills required

• Graduate of accredited Registered Nursing Program with current, unrestricted license as RN in the

Philippines preferably with experience in Utilization Review, Utilization Management, Coding, Back

office, Organizational Development, and other CPO related processes.

• At least 1 year of recent & pertinent clinical/hospital or similar experience
• Clinical Subject Matter Expertise with the use of technical and professional knowledge and skills to

accomplish results related to the process handled.

• Ability to use PC and widely used software packages, especially Microsoft Office handling of spread

sheets and word processing

• Effective oral/written communication skills
• Type minimum of 30 wpm with excellent accuracy
• Good negotiating skills
• Good interpersonal skills
• Ability to be detail oriented and be able to work independently
• Knowledge of insurance industry and claims processing