QA - Medical Coding

Overview

Quality auditor for Emergency Department medical coding, ensuring accurate code assignment, E/M level selection and compliance, and coaching coders on accuracy and documentation.

What you'll do

• Perform quality audits of Emergency Department coding to ensure accurate assignment of ICD-10-CM diagnosis codes, CPT and HCPCS procedure codes, E/M levels based on Medical Decision Making (MDM) guidelines, and appropriate modifiers in accordance with coding guidelines and payer requirements.
• Review coded encounters for compliance with AMA CPT guidelines, CMS regulations, NCCI edits, and payer-specific coding requirements.
• Validate the appropriate application of MDM components: number and complexity of problems addressed, amount and complexity of data reviewed, and risk of complications and/or morbidity.
• Identify coding trends, documentation deficiencies, and compliance risks through routine audits.
• Provide detailed and constructive feedback to coders regarding coding accuracy, productivity, and documentation opportunities.
• Conduct one-on-one and group feedback sessions to improve coding quality and consistency.
• Collaborate with Coding Leadership, Educators, Physicians, and Operational Teams to address coding issues and improve overall coding performance.
• Monitor coding quality metrics and prepare audit reports, scorecards, and trend analyses.
• Participate in root cause analysis for coding errors and implement corrective action plans.
• Assist in developing coding guidelines, audit tools, educational materials, and standard operating procedures.
• Support internal and external audit activities and respond to coding-related inquiries.
• Educate coders and providers on documentation requirements supporting accurate code assignment and E/M level selection.
• Stay current with ICD-10-CM updates, CPT and HCPCS changes, CMS guidelines, AMA E/M revisions, and ED-specific payer requirements.

What you'll need

• Strong understanding of Emergency Department workflows.
• Strong understanding of MDM-based E/M coding guidelines.
• Strong understanding of ICD-10-CM, CPT, and HCPCS coding systems.
• Minimum 3 years of Emergency Department coding experience.
• Experience reviewing provider documentation and identifying documentation improvement opportunities.
• Strong knowledge of coding compliance, regulatory requirements, and payer guidelines.
• Excellent analytical and problem-solving skills.
• Strong communication and coaching abilities.
• High attention to detail and quality-focused mindset.

Nice to have

• Certification in Medical Coding: CPC, COC, CCS, CIC, or equivalent.
• Minimum 1-2 years of coding quality review, auditing, mentoring, or senior coding experience.
• Experience performing coding audits and quality assurance reviews.
• Ability to mentor and provide actionable feedback to coding teams.
• Experience with audit scorecards, accuracy tracking, and quality reporting.
• Strong understanding of NCCI edits, LCD/NCD guidelines, and payer-specific reimbursement requirements.
• Proficiency in coding software, audit tools, encoder systems, and EHR platforms.
• Ability to identify coding trends and recommend process improvements.
• Strong organizational and time-management skills.
• Ability to work independently while collaborating effectively with cross-functional teams.
• Commitment to continuous learning and professional development.

Details

• Location: Mumbai (Vikroli), India.