About this role
Key Responsibilities
- Perform quality audits of Emergency Department coding to ensure accurate assignment of:
- ICD-10-CM diagnosis codes
- CPT and HCPCS procedure codes
- E/M levels based on Medical Decision Making (MDM) guidelines
- Appropriate modifiers in accordance with coding guidelines and payer requirements.
- Review coded encounters for compliance with:
- AMA CPT guidelines
- CMS regulations
- NCCI edits
- Payer-specific coding requirements
- Validate the appropriate application of MDM components including:
- Number and complexity of problems addressed
- Amount and complexity of data reviewed
- Risk of complications and/or morbidity
- Identify coding trends, documentation deficiencies, and compliance risks through routine audits.
- Provide detailed and constructive feedback to coders regarding coding accuracy, productivity, and documentation opportunities.
- Conduct one-on-one and group feedback sessions to improve coding quality and consistency.
- Collaborate with Coding Leadership, Educators, Physicians, and Operational Teams to address coding issues and improve overall coding performance.
- Monitor coding quality metrics and prepare audit reports, scorecards, and trend analyses.
- Participate in root cause analysis for coding errors and implement corrective action plans.
- Assist in developing coding guidelines, audit tools, educational materials, and standard operating procedures.
- Support internal and external audit activities and respond to coding-related inquiries.
- Educate coders and providers on documentation requirements supporting accurate code assignment and E/M level selection.
- Stay current with:
- ICD-10-CM updates
- CPT and HCPCS changes
- CMS guidelines
- AMA E/M revisions
- ED-specific payer requirements
Qualifications
- Certification in Medical Coding:
- CPC, COC, CCS, CIC, or equivalent preferred
- Minimum 3 years of Emergency Department coding experience.
- Minimum 1-2 years of coding quality review, auditing, mentoring, or senior coding experience preferred.
- Strong understanding of:
- Emergency Department workflows
- MDM-based E/M coding guidelines
- ICD-10-CM, CPT, and HCPCS coding systems
- Experience reviewing provider documentation and identifying documentation improvement opportunities.
- Strong knowledge of coding compliance, regulatory requirements, and payer guidelines.
- Excellent analytical and problem-solving skills.
- Strong communication and coaching abilities.
- High attention to detail and quality-focused mindset.
Preferred Skills
- Experience performing coding audits and quality assurance reviews.
- Ability to mentor and provide actionable feedback to coding teams.
- Experience with audit scorecards, accuracy tracking, and quality reporting.
- Strong understanding of NCCI edits, LCD/NCD guidelines, and payer-specific reimbursement requirements.
- Proficiency in coding software, audit tools, encoder systems, and EHR platforms.
- Ability to identify coding trends and recommend process improvements.
- Strong organizational and time-management skills.
- Ability to work independently while collaborating effectively with cross-functional teams.
- Commitment to continuous learning and professional development.