Senior Medical Coder - Outpatient Clinic Coding and Denial Management

OptiClaim · India

Senior Medical Coder – OP Clinic Coding Denial Management

Hospital Outpatient Department (HOPD) Facility Coding

Remote | Night Shift (5:30 PM – 1:30 AM IST)

About Us

OptiClaim Business Solutions provides medical coding and revenue cycle services to U.S. healthcare providers, with a dedicated team supporting hospital outpatient clinic (HOPD) coding and denial resolution. We're hiring experienced coders who bring accuracy to this hospital-based facility coding environment.

Role Overview

This role sits within our Hospital Outpatient Department (HOPD) coding team, supporting hospital-owned outpatient clinics. It is a facility coding role — not a professional fee (pro-fee) coding role. You'll code outpatient clinic encounters under the hospital's facility structure, assign facility E/M levels using HCPCS G0463, and resolve coding denials on those claims in ClaimSource, working from root-cause identification through correction and resubmission.

Key Responsibilities 

Coding

• Assign ICD-10-CM, CPT, HCPCS Level II, and modifiers for outpatient clinic (HOPD) encounters.
• Level facility visits using HCPCS G0463, based on documentation.
• Code outpatient surgeries/procedures, radiology & imaging, lab & pathology, and infusion services performed in the hospital-based clinic setting.
• Assign revenue codes and support APC grouping for facility claims.
• Apply NCCI/CCI edits and modifiers correctly within the facility coding structure.

Coding Denial Management

• Review coding denials in ClaimSource and identify the root cause.
• Cross-check claim details in Cerner, 3M, and STAR to validate facility documentation.
• Correct coding and resubmit denied claims; escalate billing-scope issues to the billing team.
• Support hold-case review in 3M, resolving or escalating pending documentation issues before billing.
• Track denial trends and flag fixes to prevent repeat denials.
• Run coding quality checks/audits to keep facility coding accuracy high.

Must-Have Expertise

• Facility E/M coding using HCPCS G0463, within a hospital outpatient clinic (HOPD) setting.
• APC logic, revenue codes, and OCE edit resolution.
• Coding denial investigation, correction, and resubmission via ClaimSource.
• Outpatient facility coding: surgeries & procedures, radiology/imaging (CPT 70010–79999), lab & pathology (CPT 80047–89398), infusion services (CPT 96360–96379), and clinic specialties such as Cardiology, PT/OT, and Wound Care.
• Common modifiers: -24, -25, -27, -57, -59, -73, -74, G0.
• Hands-on experience with 3M, Cerner, ClaimSource, and STAR.
• Comfortable working in a hospital-based (HOPD) facility coding environment. 

Qualifications

• CPC, CCS, or equivalent coding certification.
• 3+ years of outpatient facility (HOPD) coding experience.
• 2+ years resolving coding denials in an outpatient facility setting.
• Working knowledge of 3M, Cerner, ClaimSource, and STAR.
• Prior experience coding for a hospital-owned outpatient clinic preferred, over independent physician office (pro-fee) coding. 

Apply directly on the job post or send your resume to admin@opticlaim.co