Senior Medical Coder – OP Clinic Coding Denial Management

Hospital Outpatient Department (HOPD) Facility Coding

Remote | Night Shift (5:30 PM – 1:30 AM IST)

About Us

Opti Claim Business Solutions provides medical coding and revenue cycle services to U. S. healthcare providers, with a dedicated team supporting hospital outpatient clinic (HOPD) coding and denial resolution. We're hiring experienced coders who bring accuracy to this hospital-based facility coding setting.

Role Overview

This role sits within our Hospital Outpatient Department (HOPD) coding team, supporting hospital-owned outpatient clinics. It is a facility coding role — not a professional fee (pro-fee) coding role. You'll code outpatient clinic encounters under the hospital's facility structure, assign facility E/M levels using HCPCS G0463, and resolve coding denials on those claims in Claim Source, working from root-cause identification through correction and resubmission.

Key Responsibilities

Coding

Assign ICD-10-CM, CPT, HCPCS Level II, and modifiers for outpatient clinic (HOPD) encounters. Level facility visits using HCPCS G0463, based on documentation. Code outpatient surgeries/procedures, radiology & imaging, lab & pathology, and infusion services performed in the hospital-based clinic setting. Assign revenue codes and support APC grouping for facility claims. Apply NCCI/CCI edits and modifiers correctly within the facility coding structure. Coding Denial Management

Review coding denials in Claim Source and identify the root cause. Cross-check claim details in Cerner,



3 M, and STAR to validate facility documentation. Correct coding and resubmit denied claims; escalate billing-scope issues to the billing team.

Support hold-case review in 3 M, resolving or escalating pending documentation issues before billing. Track denial trends and flag fixes to prevent repeat denials. Run coding quality checks/audits to keep facility coding accuracy high.

Must-Have Expertise

Facility E/M coding using HCPCS G0463, within a hospital outpatient clinic (HOPD) setting. APC logic, revenue codes, and OCE edit resolution. Coding denial investigation, correction, and resubmission via Claim Source.

Outpatient facility coding: surgeries & procedures, radiology/imaging (CPT 70010–79999), lab & pathology (CPT 80047–89398), infusion services (CPT 96360–96379), and clinic specialties such as Cardiology, PT/OT, and Wound Care.

Common modifiers: -24, -25, -27, -57, -59, -73, -74, G0. Hands-on experience with 3 M, Cerner, Claim Source, and STAR. Comfortable working in a hospital-based (HOPD) facility coding environment. Qualifications

CPC, CCS, or equivalent coding certification. 3+ years of outpatient facility (HOPD) coding experience. 2+ years resolving coding denials in an outpatient facility setting. Working knowledge of 3 M, Cerner, Claim Source, and STAR. Prior experience coding for a hospital-owned outpatient clinic preferred, over independent physician office (pro-fee) coding. Apply directly on the job post or send your resume to admin@

📌 Senior Medical Coder - Outpatient Clinic Coding And Denial Management (Madhya Pradesh)
🏢 OptiClaim
📍 Madhya Pradesh