Medical Coder - Remote

Cigna Healthcare•North Carolina Work at Home, NC

7h•$21 - $31•Remote

About The Position

The Medical Coder is responsible for the accurate review, interpretation, and assignment of Evaluation and Management (E/M) codes, ICD-10-CM diagnosis codes, Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, modifiers, and units based on provider documentation within electronic and paper medical records for Emergency Department encounters & profession outpatient encounters. This role ensures coding accuracy, compliance with federal and state regulations, payer requirements, and industry coding guidelines. The Medical Coder serves as a subject matter expert in E/M coding and supports quality initiatives, auditing activities, provider documentation improvement, and operational excellence. The position requires strong analytical skills, attention to detail, and the ability to navigate complex coding scenarios while maintaining productivity and quality standards.

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, including one or more of the following: Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Coding Specialist (CCS), 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.

Nice To Haves

Certified Evaluation and Management Coder (CEMC) certification a plus.
Emergency Department coding experience a plus.
Knowledge of payment integrity, claim review, fraud, waste, and abuse identification.

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 established 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 all federal, state, accreditation, privacy, and organizational requirements, including HIPAA regulations.
Identify and refer potential fraud, waste, abuse, or questionable billing practices to the 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 all internal and external interactions.