Job description
Clinical Coding
• Analyse and interpret clinical documentation including discharge summaries, operative notes, clinic letters, and diagnostic reports.
• Assign accurate and compliant codes using ICD 10, OPCS 4, SNOMED CT, or other relevant coding systems.
• Ensure coding meets national standards, organisational policies, and audit requirements.
• Query clinicians when documentation is incomplete, unclear, or inconsistent.
• Maintain up to date knowledge of coding guidelines, disease processes, and medical terminology.
• Support clinical audits, data validation, and quality improvement initiatives.
Medical Note Summarising
• Review patient records and extract key clinical information into structured, concise summaries.
• Summarise past medical history, active problems, medications, allergies, safeguarding concerns, and significant events.
• Organise and update electronic health records (EHRs) to ensure clarity, accuracy, and continuity of care.
• Identify missing information and flag discrepancies to clinicians or administrative leads.
• Apply consistent summarisation standards in line with practice protocols and clinical governance.
• Assist with coding diagnoses and procedures within GP or hospital systems where required.
Operations
• Always work confidentially.
• Always work safely in accordance with legislative requirements and CRGPA/practice policies and procedures.
• Highlighting when ordering and maintenance of stationery is required
• Answer telephones and assist reception function when required, ensuring an effective and efficient reception service is provided to patients and any other visitors to the Practice
• Provide an efficient, courteous and responsive reception and telephone service to the public
• Participate in new initiatives and future changes in service delivery improvements.
• Support the Team in promoting equal opportunities in the workplace and delivering services which are accessible and appropriate to the diverse needs of service users.
• Deal with all general enquiries
• Carry out a range of administration duties including word processing and data inputting duties as required (EMIS), fax, photocopy and post.
Facilities
• Have a thorough knowledge of all procedures and work in accordance with approved protocols.
• Ensure building security, have a thorough knowledge of doors/ windows/alarm.
Other Tasks
• Contributing to the development and improvement of services to patients
• Play an active role in the induction/ training of new staff members
• Support with the delivery of other targeted services delivered by Coventry and Rugby GP Alliance
• Contributing to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance.
The duties of the post may be reviewed and, if appropriate, changed by discussion with the post holder to ensure the provision of effective and efficient services.
Job description
Job responsibilities
Clinical Coding
• Analyse and interpret clinical documentation including discharge summaries, operative notes, clinic letters, and diagnostic reports.
• Assign accurate and compliant codes using ICD 10, OPCS 4, SNOMED CT, or other relevant coding systems.
• Ensure coding meets national standards, organisational policies, and audit requirements.
• Query clinicians when documentation is incomplete, unclear, or inconsistent.
• Maintain up to date knowledge of coding guidelines, disease processes, and medical terminology.
• Support clinical audits, data validation, and quality improvement initiatives.
Medical Note Summarising
• Review patient records and extract key clinical information into structured, concise summaries.
• Summarise past medical history, active problems, medications, allergies, safeguarding concerns, and significant events.
• Organise and update electronic health records (EHRs) to ensure clarity, accuracy, and continuity of care.
• Identify missing information and flag discrepancies to clinicians or administrative leads.
• Apply consistent summarisation standards in line with practice protocols and clinical governance.
• Assist with coding diagnoses and procedures within GP or hospital systems where required.
Operations
• Always work confidentially.
• Always work safely in accordance with legislative requirements and CRGPA/practice policies and procedures.
• Highlighting when ordering and maintenance of stationery is required
• Answer telephones and assist reception function when required, ensuring an effective and efficient reception service is provided to patients and any other visitors to the Practice
• Provide an efficient, courteous and responsive reception and telephone service to the public
• Participate in new initiatives and future changes in service delivery improvements.
• Support the Team in promoting equal opportunities in the workplace and delivering services which are accessible and appropriate to the diverse needs of service users.
• Deal with all general enquiries
• Carry out a range of administration duties including word processing and data inputting duties as required (EMIS), fax, photocopy and post.
Facilities
• Have a thorough knowledge of all procedures and work in accordance with approved protocols.
• Ensure building security, have a thorough knowledge of doors/ windows/alarm.
Other Tasks
• Contributing to the development and improvement of services to patients
• Play an active role in the induction/ training of new staff members
• Support with the delivery of other targeted services delivered by Coventry and Rugby GP Alliance
• Contributing to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance.
The duties of the post may be reviewed and, if appropriate, changed by discussion with the post holder to ensure the provision of effective and efficient services.