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Coding Subject Matter Expert Consultant

0 years

0 Lacs

chennai tamil nadu india

Posted:1 week ago| Platform: Linkedin logo

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Skills Required

coding audits audit reporting compliance cpt cms training modifiers documentation ethics support risk billing management reimbursement escalation technology automation ai

Work Mode

On-site

Job Type

Contractual

Job Description

  • 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.).
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

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