Professional Coding SME (Healthcare)

Responsibilities

• The successful candidate will lead a team of coding auditors, reviewing selected professional claims for appropriate coding and reimbursement.
• Possess the coding skill set and experience to lead a team of experienced coders by demonstrating mastery of the coding guidelines, CPT classification systems, billing and reimbursement process and support tools.
• This candidate will have a strong background in professional facility coding.
• This candidate will be able to evaluate client data and review payment methodologies to determine the auditing ability of the program.
• The professional coding SME is expected to actively participate in the selections process initiatives, monitor the performance, review results and fine tune the selections queries working with the selections analytics team. In addition, the clinical specialist will ensure the audit staff is trained, aligned, and well able to achieve established goals and performance requirements.
• Will ensure all providers’ disputes are reviewed and effectively addressed.
• Provide daily support and direction of program activities.
• Contact and explanation of results to the provider community
• Participate in internal meetings to collaborate audit decisions and work towards maintaining and growing the audit program.
• The incumbent will collaborate with the overall clinical manager to ensure the program flows as expected and identify any potential barriers or areas of opportunity.

Required Qualifications

• CCS-P- Certified Coding Specialist Physician, CPC – Certified Procedural Coder. Noteworthy CCS - Certified Coding Specialist.
• RHIT - Registered Health Information Technologist.
• 10+ years’ experience with professional auditing/coding
• Strong background in surgery auditing for multiple specialties
• Expert knowledge of ICD-9, ICD-10, CPT and HCPCS coding guidelines.
• Experience with encoder tools (TrueCode, 3M, Webtrat, Pricers).
• Possess strong leadership and organizational skills, with 3-5 years of supervisory experience, the ability to develop work plans, action plans, and standard operating procedures. To include the ability to build a strong teamwork environment of inclusiveness and support.
• MS Office experience, Excel, PowerPoint, Outlook, and Word.

Professional Qualifications

• Excellent verbal / written communication skills, with the ability to lead training and team calls, etc.

What We Offer

EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions.

From your very first day, you get an opportunity to work closely with experienced, world-class Healthcare consultants.

You can expect to learn about many aspects of businesses that our clients engage in. You will also learn effective teamwork and time management skills - key aspects for personal and professional growth.

We provide guidance/ coaching to every employee through our mentoring program where in every junior level employee is assigned a senior level professional as advisors.

Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.