Cpc Medical Coder

3 hours ago

Ahmedabad, Gujarat, India Omniism Technologies Full time ₹ 15,00,000 - ₹ 30,00,000 per year

A. Medical Coding Responsibilities

  • Review outpatient clinical documentation, superbills, and encounter forms to assign accurate CPT, ICD-10-CM, HCPCS Level II, and J codes.
  • Validate and calculate infusion and injection units based on dosage, vial size, and HCPCS unit definitions.
  • Apply appropriate modifiers (25, 59, 76, 91, JW, JZ, etc.) based on procedure type and payer guidance.
  • Ensure compliance with CMS, NCCI, and payer-specific billing rules.
  • Maintain up-to-date understanding of Medicare LCDs, MUEs, bundling/unbundling edits, and CCI policies.
  • Clarify any documentation discrepancies by coordinating directly with the provider or clinical team before claim submission.
  • Review rejected or denied claims to identify root causes and recommend corrective actions related to coding or documentation.
  • Support internal and external audits, ensuring all coded services are supported by clinical documentation.

B. Medical Billing Responsibilities

  • Prepare, verify, and submit claims through clearinghouses or directly to payers following payer-specific rules.
  • Review charges and ensure coding aligns with billed services and authorization requirements.
  • Post payments, reconcile EOBs (Explanation of Benefits), and record adjustments accurately in the billing system.
  • Manage denials and rejections, correct identified errors, and resubmit claims promptly.
  • Track unpaid or underpaid claims and perform follow-up with payers to ensure timely reimbursement.
  • Handle patient billing inquiries, resolve statement issues, and explain balances when needed.
  • Monitor payer trends, claim turnaround times, and aging reports to highlight revenue risks or systemic issues.
  • Collaborate with the coding, compliance, and operations teams to ensure end-to-end billing accuracy and revenue integrity.
  • Maintain accurate documentation of all billing actions and communications for audit readiness.

Compliance and Confidentiality

  • Adhere strictly to HIPAA and HITECH privacy and security requirements.
  • Ensure all activities comply with federal, state, and payer regulations.
  • Participate in compliance training and maintain awareness of coding and billing policy updates.

Performance and Quality Expectations

  • Maintain coding accuracy 95% and billing clean claim rate 98%.
  • Ensure all claims are submitted within agreed timelines.
  • Proactively identify and correct recurring claim or documentation issues.
  • Support continuous improvement of revenue cycle workflows and best practices.

Preferred Background and Skills

  • Minimum 23 years of experience in outpatient coding and billing.
  • Strong understanding of Medicare, Medicaid, and commercial payer rules.
  • Experience in Internal Medicine, Cardiology, Rheumatology, or Oncology preferred.
  • Familiarity with EHR and practice management systems.
  • Knowledge of revenue integrity, audit processes, and drug wastage documentation.
  • Strong analytical, problem-solving, and communication skills.

Deliverables and Reporting

  • Daily: Charge review and claim submission logs.
  • Weekly: Denial and payment posting summary.
  • Monthly: Coding and billing accuracy reports, denial trends, and AR aging summary.
  • Periodic: Participation in compliance or internal audit reviews as assigned.

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