Role Description

JD Role Summary The Medical Coder is responsible for accurately assigning diagnosis and procedure codes to patient medical records based on clinical documentation, ensuring compliance with coding standards, payer guidelines, and regulatory requirements. This role requires meticulous attention to detail and a thorough understanding of ICD-10, CPT, and HCPCS coding systems. Medical coders serve as the bridge between clinical documentation and revenue cycle operations—your accuracy directly impacts claim acceptance, reimbursement, and compliance.

Key Responsibilities 1.

Medical Record

Review &

- Analysis

- Review patient medical records, physician notes, and clinical documentation for coding accuracy
- Identify missing or conflicting clinical information and request clarifications from providers
- Analyze complex cases involving multiple diagnoses and procedures 2. Diagnosis &
- Procedure Code Assignment
- Assign appropriate ICD-10 diagnosis codes based on clinical documentation
- Assign CPT and HCPCS procedure codes reflecting services provided
- Apply coding guidelines, conventions, and official coding directives accurately
- Ensure codes reflect the highest level of specificity required 3.

Documentation Quality

Review

- Flag incomplete or ambiguous documentation that impacts coding accuracy
- Communicate documentation gaps to clinical teams and providers
- Support improvement of clinical documentation practices across the organization 4. Compliance &

- Audit Readiness
- Maintain knowledge of current coding guidelines and regulatory changes (CMS, payer-specific rules)




- Adhere to compliance standards and internal coding policies
- Prepare records for audits with properly substantiated and accurate coding 5.

Code Quality &

- Accuracy
- Perform self-audits and quality checks on assigned cases
- Respond constructively to QA feedback and coding audits
- Maintain coding accuracy benchmarks and reduce rework/denials 6. Workflow &
- Productivity Management
- Process assigned cases within established turnaround times (TAT)
- Manage daily queue while maintaining quality standards
- Support backlog reduction initiatives and aging case management 7.

Compliance

Checks &

- Risk Identification
- Identify potential coding errors, fraud risks, or billing compliance issues
- Escalate high-risk cases or unusual coding scenarios to supervisors
- Maintain documentation to support audit trails 8. System &
- Tool Management
- Use coding software and EMR systems efficiently
- Update coding records and track case status in internal systems
- Maintain organized documentation for continuity and audits Skills &
- Competencies
- Core Coding Knowledge: o Proficiency in ICD-10, CPT, and HCPCS coding systems o Understanding of medical terminology and anatomy o Knowledge of coding guidelines, conventions,



and official coding directives o Familiarity with major payer coding requirements (Medicare, commercial plans)
- Operational Skills: o High attention to detail and documentation accuracy o Strong analytical ability to interpret clinical documentation o Ability to work efficiently under volume and time pressures o Comfortable with coding software and EHR platforms
- Professional Qualities: o Commitment to compliance and regulatory standards o Problem-solving mindset when facing ambiguous or complex cases o Strong communication with clinical, QA, and operations teams o Willingness to stay current with coding updates and industry changes Experience &
- Qualification Experience:
- 2–5+ years of medical coding experience (inpatient, outpatient, or combined)
- Healthcare BPO or healthcare provider workplace preferred
- Experience with major coding audits and compliance reviews a plus Education:
- High school diploma/GED required; some college preferred
- Professional coding certification (RHIT, CPC, or equivalent) preferred or willingness to pursue within 12 months
- Formal coding course completion or medical coding program graduate KPIs / Performance Metrics
- Coding accuracy rate (target: 98%+)
- First-pass accuracy / rework reduction
- Daily case volume and TAT adherence
- Audit compliance score
- Response time to documentation requests
- Internal QA scoring consistency Willing to work in second shift, 5 days from office. Locations :
- TVM, KOC, CHN

Skills CPT, ICD-10-CM, HCPCS, Claims Management

📌 Associate II - BPM (Kochi)
🏢 UST
📍 Kochi