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.