Responsibilities
•Lead and manage a team of medical coding specialists, ensuring accurate and timely auditing of multi-specialty surgical claims.
•Provide coaching, training, and mentorship to enhance team performance and foster a collaborative work environment.
•Oversee coding workflows, assign priorities, and ensure productivity, quality, and turnaround time targets are consistently achieved.
•Stay current with coding guideline updates, payer policies, regulatory changes, and industry best practices, and communicate relevant updates to the team.
•Conduct regular coding audits and quality reviews to ensure compliance with coding standards, documentation requirements, and organizational policies.
•Collaborate with cross-functional teams, including Analytics, Repricing, Quality, and Compliance, to optimize coding operations and resolve coding-related issues.
•Monitor and analyze key performance indicators (KPIs), identify performance gaps, and implement continuous improvement initiatives.
•Apply payment integrity principles to identify coding inaccuracies, documentation deficiencies, billing errors, and revenue optimization opportunities.
•Serve as the subject matter expert (SME) for multi-specialty surgical coding and payment integrity, providing guidance to internal stakeholders and supporting accurate documentation and coding practices.
•Ensure compliance with healthcare regulations, including HIPAA, HITECH, CMS, Medicare, and commercial payer requirements.
Requirements
•Strong expertise in multi-specialty surgical coding, auditing, and payment integrity processes.
•In-depth knowledge of ICD-10-CM, CPT, HCPCS, modifier usage, and payer-specific coding guidelines.
•Comprehensive understanding of CMS, Medicare, Medicaid, LCDs, NCDs, commercial payer policies, and reimbursement methodologies.
•Proficiency in coding software, auditing tools, and Electronic Health Record (EHR) systems.
•Strong analytical and problem-solving abilities with a focus on identifying coding discrepancies and implementing process improvements.
•Excellent leadership, coaching, and team management skills.
•Effective communication and stakeholder management skills with the ability to collaborate across departments.
•High attention to detail and commitment to coding accuracy, compliance, and quality standards.
•Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment.
•Sound knowledge of healthcare regulations, including HIPAA, HITECH, and industry compliance requirements.
Experience
•CPC+ 7 years' experience in DRG coding area.
•Auditing and denial management experience (Optional).
•Extensive experience in medical coding, with a focus on surgery coding and strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
Qualification
•Bachelor's degree in clinical or healthcare information management or a related field. Relevant certifications (e.g. CCS, CPC, CPMA) are mandatory.
Communication Skill
•Strong written (documentation) and oral communication skills.
Working Hours
•40 hours per week as Full-time employee.
•Shift time: 8:00 PM IST - 5:00 PM IST.
•Weekends Off.
Telecommuter/Internet requirements, if applicable
•High Speed internet connection at home, must be broadband.
•Must understand and adhere with telecommuter policy.
