- Previously operated as a certified coder, coding certified by AAPC or AHIMA (CCS or CPC), with 4+ years of experience.
- Understands multi-payer systems, including Medicare, Medicaid, commercial, and value-based models, and the coding impact on revenue, quality, and compliance.
- Multi-dimensional expert in coding, reimbursement and grouping methodologies, CMS regulations, OIG compliance expectations, NCCI edits, local coverage determination, and audit risk.
- Clinical validation and documentation judgment skills needed to evaluate provider documentation context, clinical nuances beyond coding and reimbursement guidelines, and appeals.
- Ability to align with clinicians, clinical coders, and technology teams.
- Middle revenue cycle consulting experience to bring broad HIM industry perspectives to the role.
- Shift timings: 1.30 PM to 11 PM
📌 Business System Consultant (Bengaluru)
🏢 Optum
📍 Bengaluru
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