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.
• •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.