Coding Subject Matter Expert Consultant

Job Description – Coding Subject Matter Expert Consultant

1. Coding Quality Assurance & Audit

• Perform regular and random coding quality audits on work completed by frontline coders.
• Identify errors, trends, and root causes, and provide actionable feedback to coders.
• Develop audit tools, checklists, and reporting dashboards to track performance.
• Ensure compliance with ICD-10, CPT, HCPCS, payer-specific, and federal guidelines (CMS, OIG, etc.).

2. Training & Development

• Conduct training sessions on specialty-specific coding (CPT, ICD-10, modifiers, NCCI edits, payer rules).
• Train coders on general best practices including documentation review, coding ethics, and compliance.
• Develop training materials, manuals, and knowledge repositories for ongoing skill enhancement.
• Mentor new coders and provide refresher training based on audit findings.

3. Clinical Documentation Improvement (CDI)

• Collaborate with providers to improve clinical documentation quality and completeness.
• Educate providers on documentation requirements that support coding accuracy and risk adjustment (HCC, RAF).
• Identify documentation gaps and recommend corrective actions.
• Participate in provider feedback loops to align clinical notes with coding compliance.

4. Stakeholder Collaboration

• Attend regular meetings with providers, U.S. client teams, and internal leadership.
• Partner with the Compliance Team to implement updated coding guidelines and compliance programs.
• Liaise with revenue cycle teams to align coding with billing, denial management, and reimbursement goals.

5. Compliance & Best Practices

• Monitor and interpret updates from CMS, AMA, AAPC, AHIMA, and payer bulletins.
• Establish and enforce coding policies, SOPs, and compliance standards.
• Support internal and external audits by ensuring readiness and documentation availability.
• Act as the coding escalation point for complex or disputed cases.

6. Continuous Improvement & Innovation

• Recommend process improvements to enhance coding accuracy and efficiency.
• Collaborate with technology/automation teams to integrate coding tools, AI-assisted coding, and compliance checks.
• Track KPIs such as accuracy %, audit scores, coder productivity, and denial trends.
• Support implementation of corrective action plans based on audit results.