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.