Medical EM OP QA / QC

We are seeking a highly detail-oriented Medical EM (Evaluation and Management) OP (Outpatient) Quality Assurance (QA) / Quality Control (QC) specialist. The ideal candidate will have expert knowledge of EM and Outpatient coding guidelines, ensuring the highest standards of coding accuracy, compliance, and documentation integrity for outpatient encounters. This role is crucial for accurate billing and efficient revenue cycle management.

Key Responsibilities

• Conduct rigorous QA/QC reviews of Evaluation and Management (E&M) and Outpatient (OP) medical coding.
• Identify and analyze coding discrepancies, documentation deficiencies, and compliance risks specific to E&M and Outpatient services.
• Provide precise and constructive feedback to coders to improve their accuracy and understanding of complex E&M rules.
• Ensure all coding practices comply with official coding guidelines (e.g., CPT, ICD-10-CM), payer requirements, and industry standards.
• Collaborate with coding teams and clinical documentation specialists to enhance documentation quality.
• Participate in the development and implementation of quality improvement programs and training materials.
• Track and report on coding accuracy rates and identified error trends.

Qualifications

• Certification: Must be a certified professional coder with expertise in EM and Outpatient coding.
• Experience: Proven experience in EM/Outpatient medical coding and/or auditing.

Skills

• Exceptional attention to detail and strong analytical skills.
• In-depth knowledge of E&M guidelines, CPT, and ICD-10-CM coding for outpatient services.
• Ability to effectively interpret complex clinical documentation for accurate code assignment.
• Excellent communication and interpersonal skills for providing feedback and collaborating across teams.
• Proficiency in medical coding software and electronic health record (EHR) systems.