Urgent Care Coder (PRN)

Description

Performs day-to-day professional-fee coding for urgent care partner organizations on a PRN (as-needed) basis. Translates urgent care visit documentation into accurate, compliant claims data to support clean claims and reduce downstream denials. Provides flexible coding capacity during volume surges, coverage gaps, and backlog reduction, and escalates documentation and coding issues to project leadership as needed.

Duties and Responsibilities

Coding Operations

• Reviews urgent care encounter documentation and assigns accurate CPT, HCPCS, ICD-10-CM, and applicable modifier codes.
• Assigns evaluation and management (E/M) levels based on current AMA guidelines for medical decision making or total time.
• Codes common urgent care procedures and services, including laceration repair, incision and drainage, fracture and splint care, injections and infusions, vaccines, in-house laboratory testing, and point-of-care imaging.
• Applies modifiers appropriately, including -25, -59, and laterality modifiers, and reports supplies and drug administration (HCPCS J-codes) when supported by documentation.
• Meets established productivity and accuracy benchmarks, to be defined with the client.
• Queries providers when documentation is unclear, incomplete, or conflicting, and tracks query responses to resolution.

Compliance and Knowledge

• Applies NCCI edits, CMS and AMA guidelines, and payer-specific policies to ensure compliant coding.
• Maintains the confidentiality and security of PHI in accordance with HIPAA and client requirements.
• Knows, understands, incorporates, and demonstrates the Healthrise Core Values.

PRN Engagement

• Accepts and completes assignments within agreed turnaround times, communicating availability and capacity clearly to project leadership.
• Ramps quickly on client-specific coding policies, EHR workflows, and billing models for each assignment.

Quality and Process Improvement

• Participates in quality audits, feedback sessions, and ongoing education, and incorporates feedback into daily work.
• Identifies and escalates trends in denials, documentation gaps, or coding issues to project leadership.
• Documents all actions and query outcomes in the client’s coding and billing systems.
• Performs other duties as assigned.

Requirements

Required

• Active professional coding credential in good standing, such as CPC, CCS, or CCS-P.
• Minimum of two (2) years of recent, hands-on urgent care, emergency department, or ambulatory professional-fee coding experience.
• Working knowledge of CPT, HCPCS Level II, ICD-10-CM, E/M guidelines, modifiers, and NCCI edits.
• Ability to accept short-notice assignments and meet agreed turnaround times [minimum weekly availability, if any].
• Located in and authorized to work in the United States.
• Reliable high-speed internet and a secure workspace that meets HIPAA requirements.
• Excellent written and verbal communication and organizational skills.
• Attention to detail, accuracy, and time management.

Preferred

• Certified Emergency Department Coder (CEDC) or Certified Evaluation and Management Coder (CEMC).
• Experience coding occupational medicine, workers’ compensation, or self-pay urgent care visits.
• Experience with major EHR and encoder platforms (Epic, athenahealth, eClinicalWorks, Cerner/Oracle Health, 3M, Optum, or equivalent).
• Prior PRN, contract, or project-based coding experience.
• Demonstrated accuracy rate of 95% or higher.
• Completion of regulatory/mandatory certifications.