Medical Coders – ED

Key Responsibilities

ED Coding & Documentation Review

• Review Emergency Department medical records, including ED provider notes, triage documentation, nursing notes, and discharge summaries.

• Assign accurate ED E&M CPT codes (99281–99285) based on documented services and/or time, in compliance with U.S. coding guidelines.

• Apply appropriate ED-related modifiers (e.g., -25, -57) where applicable.

• Ensure documentation supports the level of ED service billed and meets payer requirements.

Quality & Accuracy

• Maintain productivity and quality benchmarks (target accuracy ≥ 95%).

• Participate in internal audits and quality reviews.

• Identify and correct ED coding discrepancies to reduce denials and downcoding.

• Implement audit feedback to improve coding quality.

Compliance & Regulatory Standards

• Ensure adherence to CMS, Medicare, and payer-specific ED coding policies.

• Maintain strict HIPAA compliance and protect PHI.

• Follow internal SOPs, coding standards, and compliance guidelines.

Collaboration & Communication

• Work closely with QA teams, auditors, team leads, and operations managers to resolve ED coding issues.

• Communicate with clinical teams to clarify unclear or incomplete ED documentation.

• Participate in training sessions and continuous improvement initiatives.

Continuous Learning

• Stay updated on ED E&M CPT updates, CMS regulations, and payer guidelines.

• Participate in ongoing education and professional development programs.

Qualifications & Skills

Education

• Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or a related field (preferred).

Experience

• Minimum 1 year of hands-on experience in Emergency Department (ED) Medical Coding.

• Proven experience coding ED E&M services (99281–99285).

• Familiarity with ED workflows and documentation standards.

Certifications (Mandatory)

• Active coding certification is required.

• Accepted certifications include:

  • CPC

  • COC

  • CCS

• Candidates without certification are not eligible.

Skills

• Strong knowledge of ED E&M CPT guidelines and documentation requirements.

• Excellent attention to detail and accuracy.

• Ability to meet productivity and quality benchmarks in a fast-paced ED environment.

• Clear written and verbal communication skills.

• Strict adherence to SOPs and compliance standards.