ENM OP / Ed facility / Surgery - Coder , QA

Key Responsibilities:

Medical Coding Responsibilities:

• Review clinical documentation and assign accurate codes for ENM OP visits, Emergency Department (ED) services, and Surgical procedures using ICD-10-CM, CPT, and HCPCS coding systems.
• Apply knowledge of CPT modifiers, NCCI edits, bundling, and payer-specific guidelines.
• Ensure compliance with CMS, AAPC, AHIMA, and other regulatory standards.
• Clarify documentation through provider queries when necessary.
• Collaborate with billing and clinical teams for smooth claim submission.

Quality Assurance (QA) Responsibilities:

• Perform detailed audits on coded medical records to ensure accuracy and completeness.
• Identify coding errors, inconsistencies, and opportunities for improvement.
• Provide feedback and coaching to coding teams to enhance coding quality.
• Prepare QA reports and maintain documentation for compliance and audits.
• Monitor compliance with internal SLAs and external regulatory requirements.

Requirements:

• Education: Graduate in Life Sciences, Paramedical, or Healthcare-related fields.
• Certifications: CPC, CCS, COC, or equivalent medical coding certifications mandatory. QA certifications or training preferred.
• Experience:
• Minimum 15 years coding experience in ENM OP, ED facility, and surgical coding.
• QA experience in healthcare coding is an added advantage.
• Tools: Proficiency in EMR/EHR systems (Epic, Cerner, Meditech) and coding software (3M, TruCode, Optum Encoder).
• Skills: Strong knowledge of medical terminology, anatomy, and coding guidelines. Attention to detail and analytical mindset.