Medical Coder

Key Responsibilities

• Review and analyse patient records to accurately identify and abstract diagnoses, co-morbidities, complications and procedures relevant to each inpatient episode.
• Assign accurate ICD-10 and OPCS-4 codes in accordance with national clinical coding standards, conventions and guidelines.
• Code complex clinical specialties and deceased patient records, liaising with clinicians where required to ensure accuracy and completeness.
• Maintain high standards of coding quality and productivity, contributing to the delivery of timely and reliable clinical data.
• Provide expert advice on complex coding issues, explaining coding decisions and rationale to clinical, medical and administrative staff.
• Collaborate with clinicians to clarify diagnoses, procedures and emerging clinical practices to support accurate code assignment.
• Share specialist knowledge and provide support, guidance and technical advice to colleagues within the Clinical Coding team.
• Plan and manage a personal workload effectively, working independently to meet agreed objectives and deadlines.
• Contribute to the achievement of monthly coding targets and support team performance during periods of absence or increased workload.
• Use patient administration, pathology, radiology and other clinical systems to gather and validate information required for coding.
• Ensure coded data, patient demographics and admission, transfer and discharge details are recorded accurately and promptly.
• Identify and report data quality issues to ensure patient activity is accurately captured within Trust systems.
• Maintain professional competence through continuous learning, participation in coding reviews and completion of mandatory national refresher training.
• Contribute to the continuous improvement of coding quality, data accuracy and compliance with national standards.

Qualifications Essential

• NCCQ Accreditation (ACC)
• Clinical Coding Standards Refresher training certification within last 3 years
• Degree or equivalent training and experience