Senior Executive - Coding Auditor

Sr. Executive – Surgery Coder (indian RN) is responsible for performing accurate coding and clinical validation audits across multiple surgical specialties. This role requires applying clinical knowledge and analytical skills to review medical records and ensure compliance with coding guidelines and payer requirements. The candidate will handle outpatient surgery, IVR, infusion/injection, and radiation oncology coding while meeting quality and productivity targets. Additionally, the role demands strong communication, adherence to SOPs, and collaboration with internal teams.

Responsibilities

• • Perform clinical validation audits and accurately code medical records for multi-specialty surgical cases.
  • Review and interpret medical documentation to ensure complete and compliant coding.
  • Adhere strictly to SOPs, project guidelines, and coding standards.
  • Meet defined quality and productivity targets consistently.
  • Identify issues, escalate concerns, and highlight coding/documentation trends.
  • Maintain daily logs including productivity, clarification logs, and audit trackers.
  • Communicate effectively with Managers/TLs for clarifications and respond promptly to emails.
  • Ensure compliance with HIPAA, OIG, and organizational policies.

Qualifications

• Qualifications & Requirements

  • Bachelor’s degree (or equivalent) in Nursing / Life Sciences / Paramedical field.
  • Active state nursing license – mandatory.
  • CPC certification required (CPMA is an added advantage).
  • Minimum 3+ years of experience in surgery coding post CPC certification.
  • Strong experience in multi-specialty surgery coding including Outpatient Surgery, IVR, General Surgery, Infusion & Injection, and Radiation Oncology.
  • Knowledge of APC facility coding is an added advantage.
  • Auditing and denial management experience (optional but preferred).
  • Strong analytical and critical thinking skills for medical record review.
  • Good communication skills (both written and verbal).
  • Proficiency in computer applications and coding tools.
  • All certifications and licenses must be active.
  • Flexible, reliable, and detail oriented.

  Work Schedule & Telecommuter Requirements

  • Full-time role: 40 hours per week.
  • Shift: 08:00 AM – 05:00 PM IST (Weekends off).
  • High-speed broadband internet connection required for remote work.
  • Must adhere to telecommuter and data security policies.