01Key Responsibilities
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Act as the primary SME for multispecialty E/M coding (OP & IP).
- Review and validate E/M levels using AMA Guidelines, MDM, and payor specifications.
- Provide specialty-specific expertise (Primary medicine, podiatry, pediatrics, psychiatry, surgery, Orthopedics, etc.).
- Conduct audits, root cause analysis, and compliance reviews to maintain coding accuracy.
- Mentor, train, and support coders and auditors on complex E/M cases.
- Collaborate with providers to resolve documentation issues and improve accuracy.
- Support denial prevention and appeals with transparent coding justifications.
- Stay updated with AHA Coding Clinic, CPT Assistant, CMS updates, and payer policy changes.
- Create best practices, SOPs, and training modules for E/M coding.
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Qualifications & Skills:
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Certification: CPC, CCS, CIC, or COC required (additional specialty certifications a plus).
- Experience: 8+ years of inpatient and outpatient E/M coding with exposure to multiple specialties.
- In-depth knowledge of AMA E/M Guidelines and IP E/M coding (Initial, Subsequent, Critical Care, Consults, Discharge services).
- Strong expertise in Specialty EM s podiatry, pediatrics, psychiatry, and surgery documentation and coding nuances.
- Excellent understanding of ICD-10-CM, CPT, HCPCS, modifiers, and payer rules.
- Prior experience as trainer, auditor, or SME in coding operations preferred. .
