Senior Executive - Coding Auditor

• Skills Required
• Strong analytical and critical-thinking skills
• Excellent medical record review and interpretation skills
• Effective written and verbal communication
• Ability to work independently and manage multiple priorities
• Knowledge of denial management and appeals processes
• Strong problem-solving and research capabilities
• Performance Metrics
• Quality Accuracy ≥ 98%
• Achievement of Productivity Targets
• SLA/TAT Adherence
• Compliance with Process and Documentation Standards
• Minimal Audit Defects and Rework

Responsibilities

• • Review and resolve Code Edit, Provider Payment Integrity (PPI), PCI, and Appeals work queues.
  • Analyze medical records, provider documentation, claim history, and coding guidelines.
  • Validate CPT, HCPCS, ICD-10-CM, modifiers, and reimbursement methodologies.
  • Apply CMS, NCCI, Medicare, Medicaid, and commercial payer editing guidelines.
  • Research coding disputes and provide supporting rationale for determinations.
  • Maintain productivity, quality, and turnaround time targets.
  • Escalate complex coding scenarios and policy interpretation issues appropriately.
  • Update productivity, clarification, and audit logs daily.
  • Participate in internal and external quality audits.
  • Identify trends and recommend process improvements.
  • Ensure compliance with HIPAA, OIG, and organizational policies.
  • Respond promptly to client and leadership communications. 

Qualifications

• Qualifications & Experience

  • Life Science / Paramedical / Healthcare-related degree
  • Active CPC, CCS certification
  • Strong knowledge of CPT, HCPCS, ICD-10-CM, NCCI edits, CMS guidelines, and payer policies
  • Proficiency in MS Office and healthcare applications

  • Willing to work in Eastern (US) shift when required

    Experience

  • Minimum 2+ years of medical coding experience
  • Experience in Surgery, E&M, or Denial Management is mandatory.
  • Experience in code edit review, appeals, grievances, provider disputes, or payment integrity programs is an advantage

  Working Hours

  • Full-time (40 hours per week)
  • Shift timing based on business requirements
  • Weekends Off (subject to project need)