* Review and audit medical claims against patient medical records to ensure
accuracy and completeness of documentation.
* Identify discrepancies between clinical documentation and billed services,
highlighting variances and potential billing errors.
* Perform detailed clinical reviews to validate diagnosis, procedures, and
level of care in accordance with industry standards.
* Ensure compliance with CMS guidelines, payer policies, and regulatory
requirements during claim review processes.
* Conduct best practice audits to identify documentation gaps, coding
inaccuracies, and revenue leakage opportunities.
* Provide structured findings and audit reports with explicit recommendations for
corrective action and process improvement.




* Collaborate with coding, billing, and provider teams to resolve audit
findings and support accurate claim submissions.
* Monitor trends in audit results and identify recurring issues requiring
targeted education or intervention.
* Support quality assurance initiatives by maintaining audit accuracy
benchmarks and meeting productivity standards.
* Participate in continuous improvement activities, including updates on CMS
regulations, clinical guidelines, and payer policy changes.

📌 Senior Executive (Chennai)
🏢 EXL
📍 Chennai