Sr. Executive /Executive - ED Facility Medical Coder

An ED Facility Medical Coder is responsible for reviewing Emergency Department documentation and accurately assigning medical codes for facility billing, compliance, reimbursement, and reporting purposes.

Key Roles & Responsibilities

1. Medical Coding & Charge Capture

• Review Emergency Department patient records, physician notes, nursing documentation, diagnostics, procedures, and treatment details.
• Assign accurate ICD-10-CM, CPT, HCPCS, and facility E/M codes based on official coding guidelines.
• Ensure appropriate charge capture for ED services, procedures, medications, and supplies.

2. Documentation Review

• Analyze medical records for completeness, accuracy, and code assignment.
• Identify missing, incomplete, or inconsistent documentation.
• Query providers when clarification is required to support accurate coding.

3. Emergency Department Facility Coding

• Determine appropriate ED facility levels based on hospital-specific criteria and resource utilization.

• Code emergency procedures such as:

• Laceration repairs

• Fracture care

• Infusions and injections

• Observation services

• Wound care

• ECGs and other ancillary services

4. Compliance & Quality Assurance

• Ensure coding practices comply with:

• ICD-10-CM Official Guidelines

• CPT/HCPCS regulations

• CMS requirements

• Hospital policies and compliance standards

• Maintain coding accuracy and productivity targets.

5. Denial Prevention & Resolution

• Review coding-related claim denials.
• Identify root causes and recommend corrective actions.
• Recode and resubmit claims when necessary to optimize reimbursement.

6. Auditing & Quality Improvement

• Participate in internal and external coding audits.
• Implement audit feedback to improve coding accuracy.
• Monitor coding trends and identify opportunities for process improvement.

7. Collaboration & Communication

• Work closely with:

• Physicians

• ED nursing staff

• Clinical Documentation Improvement (CDI) teams

• Revenue Cycle and Billing departments

• Provide coding guidance and education regarding documentation requirements.

8. Productivity Management

• Meet daily coding productivity standards.
• Prioritize accounts based on discharge dates, payer requirements, and turnaround time goals.
• Maintain coding queues and ensure timely claim submission.

9. Regulatory Updates & Continuous Learning

• Stay current with annual coding updates and healthcare regulations.
• Attend coding education sessions and training programs.
• Maintain coding certifications and continuing education requirements.

Required Skills

• Strong knowledge of ICD-10-CM, CPT, HCPCS Level II coding systems.
• Experience with Emergency Department Facility Coding.
• Understanding of medical terminology, anatomy, physiology, and pharmacology.
• Knowledge of healthcare reimbursement methodologies and billing regulations.
• Proficiency with EHR/EMR systems and encoder software.
• Excellent analytical, organizational, and communication skills.

Preferred Certifications

• CPC (Certified Professional Coder)
• CCS (Certified Coding Specialist)
• CCA (Certified Coding Associate)
• COC (Certified Outpatient Coder)
• CRC (Certified Risk Adjustment Coder) optional

Sample KPI Metrics

• Coding Accuracy: 95%
• Productivity: As per organizational benchmarks
• DNFB (Discharged Not Final Billed) reduction
• Turnaround Time (TAT) compliance
• Denial rate reduction
• Audit score compliance

Interested candidates can share their updated resumes on [email protected] or call on 7303664683.