- Skills Required
- Strong analytical and critical-thinking skills
- Excellent medical record review and interpretation skills
- Effective written and verbal communication
- Ability to work independently and manage multiple priorities
- Knowledge of denial management and appeals processes
- Strong problem-solving and research capabilities
- Performance Metrics
- Quality Accuracy ≥ 98%
- Achievement of Productivity Targets
- SLA/TAT Adherence
- Compliance with Process and Documentation Standards
- Minimal Audit Defects and Rework
- Review and resolve Code Edit, Provider Payment Integrity (PPI), PCI, and Appeals work queues.
- Analyze medical records, provider documentation, claim history, and coding guidelines.
- Validate CPT, HCPCS, ICD-10-CM, modifiers, and reimbursement methodologies.
- Apply CMS, NCCI, Medicare, Medicaid, and commercial payer editing guidelines.
- Research coding disputes and provide supporting rationale for determinations.
- Maintain productivity, quality, and turnaround time targets.
- Escalate complex coding scenarios and policy interpretation issues appropriately.
- Update productivity, clarification, and audit logs daily.
- Participate in internal and external quality audits.
- Identify trends and recommend process improvements.
- Ensure compliance with HIPAA, OIG, and organizational policies.
- Respond promptly to client and leadership communications.
Qualifications & Experience
- Life Science / Paramedical / Healthcare-related degree
- Active CPC, CCS certification
- Strong knowledge of CPT, HCPCS, ICD-10-CM, NCCI edits, CMS guidelines, and payer policies
- Proficiency in MS Office and healthcare applications
Willing to work in Eastern (US) shift when required
Experience
- Minimum 2+ years of medical coding experience
- Experience in Surgery, E&M, or Denial Management is mandatory.
- Experience in code edit review, appeals, grievances, provider disputes, or payment integrity programs is an advantage
Working Hours
- Full-time (40 hours per week)
- Shift timing based on business requirements
- Weekends Off (subject to project need)
Skills Required
- Strong knowledge of CPT, ICD-10-CM, modifiers, E&M, and surgical coding
- Good understanding of Anatomy & Physiology
- Mandatory certification: CPC or CCS (No Apprentice credentials)
- Excellent communication skills with neutral accent (mandatory for calling role)
- Prior experience in voice process
- Ability to work in Eastern (US) shift
- High energy level with proactive and spontaneous approach
- Strong analytical and problem-solving skills
- Proficiency in MS Office (Excel & PowerPoint)
- Ability to understand client requirements and deliver accordingly
- Comfortable working in telecommuting (remote/hybrid) setup with stable internet and distraction-free environment
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.
