Medical Coder
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Job Description
Medical Coder reviewing E/M and healthcare claims for Cigna’s health services businesses. Ensuring accurate, compliant reimbursement coding across Emergency Department encounters.
Responsibilities:
- Accurately assign E/M, ICD-10-CM, CPT, HCPCS, modifiers, and quantities based on medical record documentation for Emergency Department facility and professional fee encounters
- Review clinical documentation to ensure code assignment is supported and compliant with current coding guidelines and regulatory requirements
- Apply coding standards and payer-specific requirements to ensure accurate reimbursement and claim adjudication
- Maintain proficiency in Emergency Department coding concepts, documentation requirements, and reimbursement methodologies
- Adhere to quality assurance standards and coding accuracy requirements
- Remain current with annual and interim changes to ICD-10-CM, CPT, HCPCS, CMS, AMA, and other regulatory coding updates
- Ensure compliance with federal, state, accreditation, privacy, and organizational requirements, including HIPAA
- Identify and refer potential fraud, waste, abuse, or questionable billing practices to appropriate matrix partners
- Meet individual and team productivity, quality, and turnaround time expectations
- Manage multiple assignments and competing priorities while maintaining accuracy and compliance
- Support continuous improvement initiatives related to coding quality, workflow efficiency, and regulatory compliance
- Provide feedback regarding coding trends, documentation concerns, and reimbursement issues to leadership
- Serve as a coding resource and subject matter expert for peers, leaders, and cross-functional partners
- Assist with escalated coding reviews, problem resolution, and complex coding scenarios
- Communicate coding updates, trends, regulatory changes, and identified risks to leadership in a timely manner
- Advise management of concerns raised by healthcare professionals, providers, or business partners
- Demonstrate professionalism, collaboration, and effective communication in internal and external interactions
Requirements:
- High School Diploma or GED required
- Minimum of three (3) years of medical coding experience with a focus on Evaluation and Management (E/M) coding, or equivalent experience in Payment Integrity, claim review, audit, or healthcare reimbursement operations
- Current coding certification required: Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P)
- Strong knowledge of ICD-10-CM, CPT, HCPCS, and E/M coding guidelines
- Knowledge of healthcare reimbursement methodologies and payer requirements
- Excellent analytical, organizational, and problem-solving skills
- Strong written and verbal communication skills
- Proficiency with electronic medical records, coding applications, and Microsoft Office products
- Ability to work independently and collaboratively in a fast-paced environment
- Knowledge of payment integrity, claim review, fraud, waste, and abuse identification
- Internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload when working at home
- Certified Evaluation and Management Coder (CEMC) certification a plus
- Emergency Department coding experience a plus
Benefits:
- Annual bonus plan eligibility
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Remote work from home
- Cable broadband or fiber optic internet requirement for home working
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