Lead quality audits of coded medical records to ensure accurate CPT, ICD-10-CM, and HCPCS coding and payer compliance. Identify errors and trends, provide feedback, support training, collaborate with managers for process improvement, maintain HIPAA/OIG compliance, and handle client queries and team performance to meet production and quality goals.
- Perform detailed quality audits of coded medical records to ensure accuracy, compliance, and adherence to official coding guidelines and payer-specific requirements.
- Review and analyze clinical documentation for completeness and accuracy in assigning CPT, ICD-10-CM, and HCPCS codes.
- Identify coding errors, trends, and areas for improvement; provide actionable feedback and recommendations to the coding team.
- Collaborate with coding managers and training teams to support process improvement and coding education initiatives.
- Stay current with updates to coding standards, payer regulations, and compliance requirements.
- Must be an expert
- Team handling skill set
- Working in Quality team is an added advantage.
- Inventory management and planning
- Motivate and guide team to achieve production and quality goal set
- Follow project related protocols and instructions
- Handling team clarification
- To be proactive in handling team issues
- Problem solving skill sets
- Research on grey areas with solution
- Capable of conducting team education and training
- Skill sets to address client email and queries
- Should have more analytical skill sets
- Should be more innovative, energetic and positive thoughts
- Having skill sets to motivate teams
- Escalate issues, identify trends
- All emails from Manager should be answered promptly without fail
- Ensure compliance of entire team for HIPAA,OIG
Education - Bachelor’s Degree in Science or Nursing.
Certifications
One or more of the following mandatory certifications:
CCS – Certified Coding Specialist
CIC – Certified Inpatient Coder
CPC – Certified Professional Coder
Experience -
- 4 - 6 year of Coding with quality experience
- Specialty worked: IVR – Mandatory (Must be dealt with complex level IVR coding, cardiovascular surgery and General surgery
- 3+ years of coding experience
- CPMA certification is added advantage.
- Location –Chennai
- QC experience
Minimum 1–2 years of experience in a Quality Analyst or Quality Auditing role.
Preferred Qualifications (Desirable Criteria)
Strong proficiency in Microsoft Excel, including trackers, analysis, and reporting.
Experience working in SLA-driven, high-compliance healthcare environments.
EXL Chennai, Tamil Nadu, IND Office
Chennai, India
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