About this role
• 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:
• CPC+ 3 years' experience in multi-specialty surgery coding including IVR, General surgery, Infusion and Injection and Radiation oncology
• 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.