Job Description: 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
- Solid 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

- Responsibilities: 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: 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)

📌 Senior Executive - Coding Auditor (India)
🏢 EXL Service
📍 India