Clinical Coding Specialist

Job Description

We are seeking a qualified and experienced Clinical Coding Specialist to join our healthcare team. The successful candidate will be responsible for ensuring the accurate clinical coding of healthcare services and maintaining compliance with industry standards and coding guidelines within a Managed Healthcare environment.

Minimum Requirements

• Relevant qualification in Nursing, Pharmacy, Physiotherapy, or another Health Sciences discipline.
• Registration with the relevant South African statutory professional body (e.g., SANC, SAPC, HPCSA, or other applicable professional council).
• Minimum of 5 years' experience in clinical coding within a Managed Healthcare environment.
• Proven experience working with:
• Reference Price List (RPL)
• International Classification of Diseases, Tenth Revision (ICD-10)
• Complete Current Procedural Terminology for South Africa (CCSA)
• National Pharmaceutical Product Interface (NAPPI) coding
• Sound understanding of healthcare funding, medical schemes, and claims adjudication processes.
• Proficiency in Microsoft Office and healthcare information systems.
• Excellent analytical, communication, and problem-solving skills.

Key Responsibilities

• Accurately assign ICD-10, CCSA, RPL, and NAPPI codes to clinical records and medical claims.
• Review clinical documentation to ensure coding accuracy and completeness.
• Ensure compliance with national coding standards, medical scheme rules, and regulatory requirements.
• Validate coding for medical claims processing and reimbursement.
• Identify, investigate, and resolve coding discrepancies and queries.
• Collaborate with healthcare professionals to improve clinical documentation and coding quality.
• Conduct coding audits and implement quality assurance measures.
• Provide guidance and support on coding standards and best practices.
• Prepare coding reports and contribute to performance monitoring and compliance initiatives.
• Keep up to date with changes to coding standards, healthcare legislation, and industry guidelines.

Preferred Skills

• ICD-10 coding
• CCSA coding
• RPL application
• NAPPI coding
• Medical claims coding
• Clinical documentation review
• Managed Healthcare knowledge
• Quality assurance and auditing
• Attention to detail
• Excellent communication and interpersonal skills

How to Apply

If you meet the above requirements and have the relevant experience, click Apply Now and submit your updated CV together with proof of your professional registration and qualifications.

Only shortlisted candidates will be contacted.

Work Location: Hybrid remote in Rosebank, Gauteng