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Position Summary

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.

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.

Qualifications

• 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.
• 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.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 21 - 31 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.