Senior Medical Coder – OP Clinic Coding Denial Management

nHospital Outpatient Department (HOPD) Facility Coding

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

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nAbout Us

nOptiClaim 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 workplace.

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nRole Overview

nThis 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 ClaimSource, working from root-cause identification through correction and resubmission.

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nKey Responsibilities

nCoding

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

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- Review coding denials in ClaimSource and identify the root cause.
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- Cross-check claim details in Cerner, 3M,



and STAR to validate facility documentation.
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- Correct coding and resubmit denied claims; escalate billing-scope issues to the billing team.
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- Support hold-case review in 3M, resolving or escalating pending documentation issues before billing.
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- Track denial trends and flag fixes to prevent repeat denials.
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- Run coding quality checks/audits to keep facility coding accuracy high.
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nMust-Have Expertise

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- Facility E/M coding using HCPCS G0463, within a hospital outpatient clinic (HOPD) setting.
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- APC logic, revenue codes, and OCE edit resolution.
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- Coding denial investigation, correction, and resubmission via ClaimSource.
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- 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.
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- Common modifiers: -24, -25, -27, -57, -59, -73, -74, G0.
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- Hands-on experience with 3M, Cerner, ClaimSource, and STAR.
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- Comfortable working in a hospital-based (HOPD) facility coding environment.
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nQualifications

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

📌 Senior Medical Coder - Outpatient Clinic Coding and Denial Management (Thrissur)
🏢 OptiClaim
📍 Thrissur