QA - Medical Coding

MédiSolution (2009) Inc.; Mumbai; On-site; INR 900,000 - 1,400,000; Full time

Job summary

MédiSolution (2009) Inc. is seeking a skilled Medical Coder Quality Auditor to ensure accurate ICD-10-CM, CPT, and HCPCS coding for Emergency Department encounters. You will review documentation, provide actionable feedback, and drive compliance across CMS, NCCI, and payer guidelines.

Ideal candidates have 3+ years ED coding experience, certification in CPC/COC/CCS/CIC, and a proven track record in auditing, mentoring, and improving coding quality using encoder and EHR tools.

Qualifications

• Minimum 3 years of Emergency Department coding experience.
• Minimum 1–2 years of coding quality review, auditing, mentoring, or senior coding experience preferred.
• Strong understanding of Emergency Department workflows and MDM-based E/M guidelines.
• Proficient in ICD-10-CM, CPT, and HCPCS coding systems.
• Experience reviewing provider documentation and identifying documentation improvement opportunities.
• Strong knowledge of coding compliance, regulatory requirements, and payer guidelines.

Responsibilities

• Perform quality audits of Emergency Department coding to ensure accurate ICD-10-CM, CPT, HCPCS codes and E/M levels.
• Review coded encounters for compliance with AMA CPT guidelines, CMS regulations, NCCI edits, and payer requirements.
• Validate MDM components including problems, data reviewed, and risks.
• Identify coding trends, documentation deficiencies, and compliance risks through audits.
• Provide detailed feedback to coders on 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 Operations to address issues and improve performance.
• Monitor coding quality metrics and prepare audit reports, scorecards, and trend analyses.
• Participate in root cause analysis and implement corrective action plans.
• Assist in developing coding guidelines, audit tools, educational materials, and SOPs.
• Support internal and external audit activities and respond to 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/HCPCS changes, CMS guidelines, and E/M revisions.

Skills

Analytical thinking

Attention to detail

Coaching abilities

Communication skills

Education

CPC/COC/CCS/CIC Certification

Tools

Coding software

Encoder systems

EHR platforms

Job description

Key Responsibilities

• 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
• Appropriate modifiers in accordance with coding guidelines and payer requirements.

• Review coded encounters for compliance with: AMA CPT guidelines
• CMS regulations
• NCCI edits
• Payer-specific coding requirements

• Validate the appropriate application of MDM components including: Number and complexity of problems addressed
• Amount and complexity of data reviewed
• 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
• ED-specific payer requirements

Qualifications

• Certification in Medical Coding: CPC, COC, CCS, CIC, or equivalent preferred

• Minimum 3 years of Emergency Department coding experience.
• Minimum 1-2 years of coding quality review, auditing, mentoring, or senior coding experience preferred.
• Strong understanding of: Emergency Department workflows
• MDM-based E/M coding guidelines
• ICD-10-CM, CPT, and HCPCS coding systems

• 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.

Preferred Skills

• 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.