E&m - Op/ip--- Sme

4 days ago

Hyderabad Telangana, India Eclat Health Solutions Full time

SME - Outpatient & Inpatient E/M Coding (Multispecialty)

Job Summary:
We are seeking an experienced E/M Coding Subject Matter Expert (SME) with strong expertise in outpatient and inpatient E/M coding across multiple specialties, including podiatry, pediatrics, psychiatry, orthopedics, and surgery. The SME will act as the coding authority, ensuring compliance, accuracy, and consistency with official guidelines while mentoring and supporting coding teams.

Key Responsibilities:

- 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 clear 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.


Qualifications & Skills:

- 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.

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