- 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+ 3 years' experience in multi-specialty surgery coding including IVR, General surgery, Infusion and Injection and Radiation oncology
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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.