Description

Skills Required
Robust 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

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
Robust 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 Chennai
🏢 EXL
📍 Chennai