ED, Radiology, Denial, surgery, IPDRG, ENM Coder

Key Responsibilities:

• Review and assign accurate ICD-10-CM, CPT, and HCPCS codes based on clinical documentation.
• Assign DRGs using appropriate ICD-10-PCS for inpatient encounters (IPDRG).
• Apply correct modifiers, MDM levels, and code sequencing.
• Code various specialties including:
• ED including trauma and critical care
• Radiology diagnostic and interventional
• Surgery multi-specialty (Ortho, General, ENT, Neuro, etc.)
• E&M office visits, inpatient and outpatient
• Denials review and correct coding for re-submission of denied claims
• Ensure 95%+ accuracy and meet daily productivity benchmarks.
• Stay updated with CMS, AHA Coding Clinic, and payer-specific guidelines.
• Work closely with QA and query physicians for clarifications when necessary.

Eligibility Criteria:

• Education: Life Science / Paramedical / Nursing background
• Certifications (Mandatory): CPC / COC / CCS / CIC (AAPC or AHIMA certified)
• Experience:
• 26 years of experience in any 3 or more of the mentioned specialties
• DRG coding experience is mandatory for IPDRG role
• Denial management or re-submission coding experience preferred

Key Skills Required:

• Strong knowledge of ICD-10-CM, CPT, ICD-10-PCS, HCPCS, and DRG grouping
• Proficient in EHR and encoder tools (3M, TruCode, Optum, EPIC, Cerner)
• Understanding of medical necessity, LCD/NCD guidelines, and NCCI edits
• Analytical mindset for handling denials and appeal coding
• Strong documentation review, clinical understanding, and attention to detail