Key Responsibilities * Perform quality audits of Emergency Department coding to ensure accurate assignment of: + ICD-10-CM diagnosis codes + CPT and HCPCS procedure codes + E/M levels based on Medical Decision Making (MDM) guidelines + Appropriate modifiers in accordance with coding guidelines and payer requirements. * Review coded encounters for compliance with: + AMA CPT guidelines + CMS regulations + NCCI edits + Payer-specific coding requirements * Validate the appropriate application of MDM components including: + Number and complexity of problems addressed + Amount and complexity of data reviewed + Risk of complications and/or morbidity * Identify coding trends, documentation deficiencies, and compliance risks through routine audits. * Provide detailed and constructive feedback to coders regarding coding accuracy, productivity, and documentation opportunities. * Conduct one-on-one and group feedback sessions to improve coding quality and consistency. * Collaborate with Coding Leadership, Educators, Physicians, and Operational Teams to address coding issues and improve overall coding performance. * Monitor coding quality metrics and prepare audit reports, scorecards, and trend analyses. * Participate in root cause analysis for coding errors and implement corrective action plans. * Assist in developing coding guidelines, audit tools, educational materials, and standard operating procedures. * Support internal and external audit activities and respond to coding-related inquiries. * Educate coders and providers on documentation requirements supporting accurate code assignment and E/M level selection.



* Stay current with: + ICD-10-CM updates + CPT and HCPCS changes + CMS guidelines + AMA E/M revisions + ED-specific payer requirements Qualifications * Certification in Medical Coding: + CPC, COC, CCS, CIC, or equivalent preferred * Minimum 3 years of Emergency Department coding experience. * Minimum 1-2 years of coding quality review, auditing, mentoring, or senior coding experience preferred. * Strong understanding of: + Emergency Department workflows + MDM-based E/M coding guidelines + ICD-10-CM, CPT, and HCPCS coding systems * Experience reviewing provider documentation and identifying documentation improvement opportunities. * Solid knowledge of coding compliance, regulatory requirements, and payer guidelines. * Excellent analytical and problem-solving skills. * Strong communication and coaching abilities. * High attention to detail and quality-focused mindset. Preferred Skills * Experience performing coding audits and quality assurance reviews. * Ability to mentor and provide actionable feedback to coding teams. * Experience with audit scorecards, accuracy tracking, and quality reporting. * Strong understanding of NCCI edits, LCD/NCD guidelines, and payer-specific reimbursement requirements. * Proficiency in coding software, audit tools, encoder systems, and EHR platforms. * Ability to identify coding trends and recommend process improvements. * Strong organizational and time-management skills. * Ability to work independently while collaborating effectively with cross-functional teams. * Commitment to continuous learning and professional development.

📌 QA - Medical Coding (India)
🏢 Bizmatics India Private
📍 India