Specialty Medical Coder

Role Summary:

Job Overview:

Key Responsibilities:

Professional Coding (Physician Services):

• Review physician documentation and assign appropriate CPT, ICD-10-CM, and modifiers for ED professional services.
• Ensure coding accuracy according to E/M levelling, payer guidelines, and compliance standards.
• Validate documentation sufficiency and query providers when clarification is needed.
• Support accurate charge capture and minimize under coding or over coding risks.

Facility Coding (Hospital Services):

• Assign Revenue Codes, CPT/HCPCS, and Diagnosis codes for hospital ED facility encounters.
• Ensure compliance with CMS, payer, and hospital billing regulations.
• Accurately link procedure and diagnosis codes to reflect services rendered in the ED.
• Collaborate with billing and denial management teams to resolve coding-related rejections and denials.

Cross-functional & Leadership Responsibilities:

• Review and analyse claim denials to identify root causes and recommend corrective actions.
• Maintain detailed coding documentation per internal and client standards.
• Utilize Microsoft Excel and analytics tools to identify trends and performance gaps.
• Mentor junior coders, support skill development, and foster a high-quality work culture.
• Adhere to all organizational policies on data security, HIPAA, and confidentiality.

Education & Certifications:

• Bachelors Degree in any discipline (Science/Healthcare background preferred).
• Mandatory Certification:

  CPC, COC, or CCS/equivalent AHIMA/AAPC credential

  .

Experience Requirements:

• 0.64 years of hands-on experience in Emergency Department (ED) Professional and Facility Coding.
• Strong understanding of CPT, ICD-10-CM, HCPCS, and Revenue Codes.
• Prior exposure to EHR and billing systems such as Epic, Cerner, or Meditech preferred.
• Experience in denial management, audit readiness, and process improvement.

Key Skills & Competencies:

• In-depth knowledge of ED coding guidelines, modifiers, and payer-specific policies.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication abilities.
• High attention to detail and accuracy.