Emergency Department Coder

Job Title:

Key Responsibilities:

• Review Emergency Department (ED) medical records and assign accurate CPT, ICD-10-CM, and HCPCS codes based on provider documentation.
• Ensure appropriate code selection for ED visits, procedures, physician services, infusions/injections, critical care, and evaluation & management (E/M) levels.
• Apply official coding guidelines and payer-specific rules, including facility and professional coding as applicable.
• Validate coding accuracy to ensure proper billing, timely reimbursement, and reduce claim denials.
• Work on coding edits, denials, and resubmissions; assist in addressing audit findings and ensuring compliance.
• Keep current with updates to coding guidelines, NCCI edits, payer regulations, and CMS policies relevant to ED coding.
• Collaborate with physicians, denial management, clinical documentation improvement (CDI), and billing teams to clarify or resolve coding issues.
• Maintain productivity and accuracy benchmarks as per organizational standards.

Requirements:

• Solid knowledge of CPT (especially E/M and procedural coding), ICD-10-CM, and HCPCS Level II.

• Familiarity with ED clinical terminology, procedures (e.g., laceration repair, fracture care, splinting), and services such as trauma and critical care.

• Understanding of Evaluation & Management (E/M) leveling guidelines (1995/1997 and MDM-based 2023 guidelines).

• Awareness of facility vs. professional fee coding distinctions in ED settings.

• Knowledge of US healthcare Revenue Cycle Management (RCM), medical necessity, and compliance requirements.

• Preferred Certifications: CPC, CCS, CEDC (Certified Emergency Department Coder), or equivalent.

• Excellent attention to detail, strong analytical and communication skills, and ability to work in a high-volume environment with tight deadlines.
  

Regards,

Kavya G
HR Recruiter9342785373