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