- 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.
- 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.
Experience:
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CPC+ 7 years' experience in DRG coding area
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Auditing and denial management experience (Optional)
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Extensive experience in medical coding, with a focus on surgery coding and strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
Qualification:
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Bachelor’s degree in clinical or healthcare information management or a related field. Relevant certifications (e.g. CCS, CPC, CPMA) are mandatory.
Communication Skill:
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Strong written (documentation) and oral communication skills
Working Hours:
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40 hours per week as Full-time employee
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Shift time: 8:00 PM IST - 5:00 PM IST
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Weekends Off
Telecommuter/Internet requirements, if applicable:
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High Speed internet connection at home, must be broadband
- Must understand and adhere with telecommuter policy.
Skills Required
- CPC+ with 7 years' experience in DRG coding area
- Bachelor's degree in clinical or healthcare information management or related field
- Relevant certifications (e.g., CCS, CPC, CPMA)
- Extensive experience in surgical coding and strong knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage
- Comprehensive understanding of CMS, Medicare, Medicaid, LCDs, NCDs, and commercial payer policies
- Proficiency in coding software, auditing tools, and Electronic Health Record (EHR) systems
- Experience with auditing and denial management
- Strong leadership, coaching, team management and stakeholder communication skills
- Knowledge of HIPAA, HITECH, and healthcare compliance requirements
- High-speed broadband internet and adherence to telecommuter policy
- Strong written documentation and oral communication skills
What We Do
Choosing a digital partner is about more than capabilities — it’s about collaboration and character. Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments. At EXL, our collaboration is built on ongoing listening and learning to adapt our methodologies. We’re your business evolution partner—tailoring solutions that make the most of data to make better business decisions and drive more intelligence into your increasingly digital operations. Whether your goals are scaling the use of AI and digital, redesign operating models, or driving better and faster decisions, we’re here to partner with you to help you gain—and maintain—competitive advantage with efficient, sustainable models at scale. Our expertise in transformation, data science, and change management helps make your business more efficient and effective, improve customer relationships and enhance revenue growth. Instead of focusing on multi-year, resource- and time-intensive platform designs or migrations, we look deeper at your entire value chain to integrate strategies with impact. We use our specialization in analytics, digital interventions, and operations management—alongside deep industry expertise — to deliver solutions that help you outperform the competition. At EXL, it’s all about outcomes—your outcomes—and delivering success on your terms. Share your goals with us and together, we’ll optimize how you leverage data to drive your business forward. For more information, visit www.exlservice.com.
