QA - Medical Coding

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.


* Exp...