Position Summary
We are seeking an experienced E/M coder with strong Outpatient (OP) and Inpatient (IP) coding knowledge to support coding quality, denial prevention, and rejection resolution activities. The individual will serve as a subject matter expert (SME), assisting coders in accurate code assignment, denial analysis, and provider documentation improvement.
Key Responsibilities
- Review and resolve coding-related denials and rejections.
- Perform OP and IP E/M coding audits.
- Validate E/M level selection based on MDM and time-based guidelines.
- Identify root causes and denial trends.
- Provide coding education and feedback to team members.
- Support quality initiatives and coding accuracy improvements.
- Collaborate with Operations, Quality, and Denial Management teams.
- Assist with provider documentation clarification when needed.
Required Qualifications
- Minimum 3-5 years of E/M coding experience.
- Strong knowledge of OP and IP E/M guidelines.
- Experience reviewing coding denials and payer rejections.
- Ability to interpret medical records and apply coding guidelines accurately.
- Strong analytical and communication skills.
- CPC, CCS, or equivalent coding certification preferred.
Preferred Skills
- Strong understanding of medical necessity requirements.
- Knowledge of modifier usage and payer-specific guidelines.
- Ability to mentor and support junior coders.
- Experience in eCW, Athena & Cerner
Key Competencies
- Attention to Detail
- Critical Thinking
- Problem Solving
- Quality Focus
- Effective Communication
- Team Collaboration
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