Profession clinical coder
Clinical coders read patients' medical records. They analyse and interpret medical statements about diseases, injuries and procedures. Clinical coders convert this information into health classification codes in order to calculate treatment reimbursements, to produce statistics and to monitor health care performance.
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- Conventional / Enterprising
- Clinical coding
The matching of clinical statements with standard codes of illnesses and treatments through use of a classification system.
- Document management
The methodology of tracking, managing and storing documents in a systematic and organised manner as well as keeping a record of the versions created and modified by specific users (history tracking).
- Medical terminology
The meaning of medical terms and abbreviations, of medical prescriptions and various medical specialties and when to use it correctly.
- Professional documentation in health care
The written standards applied in the health care professional environments for documentation purposes of one`s activity.
- Review patient's medical data
Assess and review relevant medical data of patients such as X-rays, medical history and laboratory reports.
- Communicate effectively in healthcare
Communicate effectively with patients, families and other caregivers, health care professionals, and community partners.
- Maintain healthcare user data confidentiality
Comply with and maintain the confidentiality of healthcare users` illness and treatment information.
- Manage healthcare users' data
Keep accurate client records which also satisfy legal and professional standards and ethical obligations in order to facilitate client management, ensuring that all clients' data (including verbal, written and electronic) are treated confidentially.
- Use electronic health records management system
Be able to use specific software for the management of health care records, following appropriate codes of practice.
- Perform clinical coding procedures
Match and record correctly the specific illnesses and treatments of a patient by using a clinical codes classification system.
- Follow clinical guidelines
Follow agreed protocols and guidelines in support of healthcare practice which are provided by healthcare institutions, professional associations, or authorities and also scientific organisations.
- Adhere to organisational guidelines
Adhere to organisational or department specific standards and guidelines. Understand the motives of the organisation and the common agreements and act accordingly.