Role Summary

The Clinical Coder is responsible for analysing, abstracting, and assigning accurate clinical codes to patient encounters in accordance with IMH’s coding standards, MOH requirements, and international classification systems. The role ensures high‑quality coded data that supports reporting, clinical analytics, and organisational decision‑making.

Key Responsibilities

• Review and analyse inpatient and outpatient medical records to extract relevant diagnoses, procedures, and clinical information in accordance with the national and hospital coding standards.

• Assign accurate ICD‑10, SNOMED CT, and procedure codes in accordance with MOH coding guidelines, IMH policies, and international standards.

• Ensure coding completeness, accuracy, and timeliness to support Casemix reporting, billing, and national submissions

• Clarify documentation with clinicians when needed to ensure coding accuracy and resolve ambiguities.

• Perform coding audits, quality checks, and participate in continuous improvement initiatives.

• Support data validation for MOH submissions, internal dashboards, and clinical quality indicators.

• To manage and track daily uncoded/coders workload report

• Contribute to coding education for clinicians and internal stakeholders.

• Maintain up‑to‑date knowledge of coding standards, MOH circulars, and classification updates.

• Perform any other duties/tasks including admin tasks assigned by Supervisor

Requirements

• Diploma or Degree in Health Information Management / Nursing / Allied Health or related fields and equivalent

• AHIMA/ICD‑10 certification or equivalent training preferred.

• Experience in clinical coding within a hospital setting is an advantage.

• Strong understanding of medical terminology, anatomy, physiology, and clinical workflows.

• Meticulous, analytical, and able to work independently under time constraints.

• Good communication skills for clinician engagement and documentation clarification.