ENM OP - Coder , ENM - QA

Key Responsibilities:

E&M OP Coder

• Review physician documentation and code outpatient visits (office, ER, urgent care, etc.).
• Assign accurate ICD-10-CM and CPT codes based on E&M guidelines.
• Apply appropriate modifiers, MDM levels, and time-based coding when applicable.
• Ensure compliance with CMS, AAPC, and payer-specific guidelines.
• Maintain productivity and coding accuracy as per SLA.

E&M QA (Quality Analyst)

• Audit coded charts across multiple outpatient specialties (Internal Med, Family Med, ED, etc.).
• Identify coding variances, MDM level errors, and documentation gaps.
• Provide structured feedback and coaching to coders for continuous improvement.
• Stay current with CMS E&M updates and help align team standards.
• Maintain quality reports and ensure coding standards compliance.

Qualifications:

• Education: Graduate in Life Sciences, Paramedical, or Healthcare-related fields
• Certification (Mandatory): CPC, COC, CCS-P (AAPC/AHIMA)
• Experience:
• Coders: 13 years in E&M or outpatient specialty coding
• QA: 35+ years in E&M coding + minimum 12 years of auditing experience

Skills Required:

• Strong knowledge of ICD-10-CM, CPT, E&M 2021 guidelines
• Excellent understanding of Medical Decision Making (MDM) and time-based coding
• Proficient with encoder tools (3M, Optum, etc.) and EMR systems (Epic, Athena, eClinicalWorks)
• Familiar with NCCI edits, documentation integrity, and payer rules
• Strong written communication and QA documentation/reporting skills (for QA role)