3+ years of experience in medical billing or coding, with a focus on Emergency Department services
Certification CPC, CPMA, or CCS-P (AHIMA or AAPC)
In-depth knowledge of E/M guidelines, NCCI edits, CMS billing rules, and payer-specific policies
Experience using EMR and billing systems such as CMD, Change Healthcare, EPD, or GoRev
Requirements:
Conduct ED billing and coding audits for accuracy, completeness, and compliance with CPT, ICD-10, HCPCS, and payer-specific guidelines; review provider documentation to ensure it supports billed services and appropriate E/M levels
Identify patterns of undercoding, upcoding, bundling errors, or medical necessity issues; collaborate with coders, billers, and providers to correct errors and provide education/training as needed
Prepare detailed audit reports with findings, trends, and actionable recommendations; participate in internal and external audits (RAC, MAC, private payer audits)
Stay up-to-date with regulatory changes from CMS and payers; work cross-functionally with compliance, revenue integrity, and quality assurance teams to improve billing workflows and reduce audit risks; help develop internal policies and audit plans related to ED coding and billing practices
Job description
We
Conduct audits of ED billing and coding for accuracy, completeness, and compliance with CPT, ICD-10, HCPCS, and payer-specific guidelines.
Review provider documentation to ensure it supports billed services and appropriate E/M levels.
Identify patterns of undercoding, upcoding, bundling errors, or medical necessity issues.
Collaborate with coders, billers, and providers to correct errors and provide education/training as needed.
Prepare detailed audit reports with findings, trends, and actionable recommendations.
Stay up-to-date with regulatory changes from CMS, commercial payers, and industry best practices specific to emergency medicine.
Work cross-functionally with compliance, revenue integrity, and quality assurance teams to improve billing workflows and reduce audit risks.
Participate in internal and external audits (e.g., RAC, MAC, private payer audits).
Help develop internal policies and audit plans related to ED coding and billing practices.
Review clinical documentation and provide feedback.
Qualifications:
3+ years of experience in medical billing or coding, with a focus on Emergency Department services.
Certification required: CPC, CPMA, or CCS-P (AHIMA or AAPC).
In-depth knowledge of E/M guidelines, NCCI edits, CMS billing rules, and payer-specific policies.
Strong familiarity with coding for ED services, including trauma activations, procedures, and critical care.
Experience using EMR and billing systems such as CMD, Change Healthcare, EPD, or GoRev.
Excellent analytical and documentation skills.
Strong communication skills with the ability to provide constructive feedback to providers and team members.
