Key Responsibilities:
General Responsibilities:
- Analyze and review medical records for completeness and assign accurate CPT, ICD-10-CM, HCPCS, and DRG codes.
- Ensure adherence to coding guidelines as per AAPC, AHIMA, CMS, and payer-specific requirements.
- Maintain coding accuracy and productivity standards.
- Collaborate with QA and audit teams for continuous quality improvement.
- Stay updated with current coding updates, payer policies, and CMS regulations.
- Ensure HIPAA compliance and maintain confidentiality.
Specialty-wise Responsibilities:
E/M (Evaluation & Management) Coding:
- Assign accurate E/M codes for office visits, consultations, ER visits, and telehealth services.
- Interpret documentation and apply 2021 E/M Guidelines.
- Review time-based and MDM (Medical Decision Making) criteria.
Surgery Coding:
- Code operative reports across specialties such as General Surgery, Orthopedics, ENT, and Gastroenterology.
- Understand bundling, modifier usage (e.g., -51, -59, -LT/RT), and NCCI edits.
- Validate procedure codes against clinical documentation.
IPDRG (Inpatient DRG) Coding:
- Assign DRGs based on the principal diagnosis, procedures, and comorbidities.
- Apply MS-DRG and APR-DRG grouping methodologies.
- Identify POA (Present on Admission) indicators and query when needed.
Requirements:
- Education: Graduate in Life Sciences, Paramedical, or Allied Health fields.
- Certifications:
- Mandatory: CPC, CCS, or COC (AAPC or AHIMA)
- Preferred: CIC (for IPDRG), CGIC, CPMA, or specialty credentials
Experience:
- Minimum 15 years in respective coding specialties (E/M, Surgery, or Inpatient).
- Freshers with certification may apply for trainee roles.
Tools: Proficiency in EMR/EHR systems like Epic, Cerner, or Meditech, and coding software such as 3M, TruCode, or Optum Encoder.
Performance Metrics (KPI):
- Accuracy: 95% (based on QA audits)
- Productivity: Specialty-based benchmarks (e.g., charts/hour or cases/day)
- Compliance: Zero PHI breaches; adherence to internal SLAs
