ACC Lead Coder

at  University Hospitals Plymouth NHS Trust

To provide comprehensive, high quality, efficient clinical coding of inpatients and day cases using ICD 10 and OPCS4 classifications to facilitate Payment by Results, statistical and performance analysis, and clinical care/audit. The UHP Clinical Coding Department codes approximately 143,000 inpatient and day case episodes per year. Duties may also include some engagement in validation meetings with clinicians, education of junior clinicians in the importance of co-morbidity recording, building working relationships with service teams and to act as a point of contact for coding issues. Key Dimensions: The post-holder will provide comprehensive, high quality, efficient clinical coding of inpatients and day cases for a wide range of specialties and will assist the Clinical Coding Service Manager and the Performance Improvement Manager in acting as a point of reference for clinicians and other staff groups throughout the service lines.
The post-holder will provide support to other Coders. PRIMARY DUTIES & AREAS OF RESPONSIBILITY To be fully conversant with the relevant publications of International Classification of Diseases (ICD 10) and Classification of Surgical Operations and Procedures (OPCS4). To critically examine the clinical information required assigning the national codes in accordance with the national guidelines. To extract diagnoses and operations from summary sheets and health records for all inpatient and day case episodes, showing a high level of expertise across all specialties.
To classify diagnoses and operations and to accurately input onto the iPM system, every code relevant to the care episode that affects the care and influences the health status of the patient. To prioritise and code any outstanding uncoded episodes as identified by computer printouts, so that work targets, laid down by the Clinical Coding Service Manager are met. To act as a mentor giving support and advice to other more junior coding staff. To act as a specialty lead for at least one specialty, attending audit meetings as required and advising on review / audit issues to that directorate/specialty.
To ensure adherence to local procedures for clinical coding relating to individual specialties/consultants. To liaise with consultants, junior medical staff, business managers, information analysts, finance staff, clinical effectiveness and audit staff and medical secretaries to address any queries arising during the abstraction process. Assist the Clinical Coding Service Manager, and the Performance Improvement Manager, in providing support through the accuracy, timeliness and quality of coded data enabling the calculation of a set of high-level indicators (clinical indicators) that provide an overview of Hospital performance. To undergo intensive training covering all specialties of coding in order to be able to change and adapt to new coding procedures as required.
To keep abreast of current national developments pertaining to clinical coding with colleagues throughout the region and inform Trust personnel as necessary. To participate in clinical coding projects where necessary. COMMUNICATIONS & WORKING RELATIONSHIPS Performance Improvement Manager Clinical Coding Service Manager Deputy Clinical Coding Manager Clinical Coding Auditor/Trainer Clinical Coding staff Clinicians Junior Medical Staff Care Group staff Ward staff Central Records Library staff OTHER To undertake any other duties as required by the Clinical Coding Service Manager Maintain personal and professional development to meet the changing demands of the job Ensure that expertise within your area is seen as a resource within and outside the Trust and form working partnerships with other health service providers. Adhere to policy and recommendations relating to data security and confidentiality.
To be familiar with and adhere to the Health and Safety Policy and other Trust policies and procedures

Please refer the Job description for details