- Job Role: Auditors-Surgery
- Experience (In Years): 12-15
- Job Location: Chennai
Experience:
- 10–15 years of experience in US Healthcare Medical Coding, Coding Quality, Auditing, or Payment Integrity.
- Strong experience managing coding quality programs across multiple specialties and/or complex healthcare processes.
- Proven experience in client management, quality governance, process improvement, and operational transformation.
- Experience with coding audits, root-cause analysis, quality analytics, performance benchmarking, and corrective action planning.
- Experience leading large teams and mentoring coding auditors, SMEs, and quality professionals.
- Exposure to Lean/Six Sigma, automation, analytics, and technology-enabled quality improvement initiatives is preferred.
Responsibilities
- Drive coding quality governance and process management to consistently meet or exceed client SLAs, quality targets, and contractual requirements.
- Partner extensively with clients to understand coding requirements, establish quality benchmarks, define performance baselines, and set appropriate quality targets.
- Develop and execute coding quality strategies, audit frameworks, and continuous improvement programs aligned with client and business objectives.
- Lead root-cause analysis of coding errors and drive corrective and preventive actions to improve accuracy and reduce repeat defects.
- Oversee quality dashboards, trend analysis, sampling methodologies, audit outcomes, and performance reporting to identify improvement opportunities.
- Act as the key business interface between client quality/transformation teams and EXL Operations, Quality, Analytics, Technology, and Transformation teams.
- Build strong relationships with key client stakeholders and influence decision-making through data-driven insights and quality improvement recommendations.
- Drive standardization and adoption of coding best practices across processes, specialties, and client engagements.
- Promote a Lean Six Sigma culture and use quality tools and methodologies to improve process efficiency, accuracy, and customer outcomes.
- Mentor and develop quality leaders, auditors, SMEs, and Lean Six Sigma professionals to build a strong quality capability.
- Lead quality transition and implementation activities for new processes, including requirement gathering, quality framework design, audit plan development, and implementation support.
- Ensure coding quality programs comply with client requirements, internal governance standards, regulatory guidelines, and relevant industry/certification requirements.
- Identify opportunities for automation, analytics, AI, and technology-enabled quality improvements in coding processes
- Support RFP/RFI responses, solutioning, and business development initiatives by providing coding quality expertise, metrics, governance models, and transformation case studies.
- Participate in client visits, governance forums, and executive discussions to showcase quality performance, improvement initiatives, and transformation outcomes.
- Facilitate knowledge sharing and benchmarking of coding quality practices across EXL and the broader healthcare industry.
- Drive a culture of accountability, continuous improvement, and customer-centricity across the coding quality organization
Qualifications
- Bachelor’s degree in Life Sciences, Healthcare, Nursing, or a related discipline.
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification preferred.
- Lean Six Sigma certification (GB/BB) preferred.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, NCCI, CMS guidelines, payer policies, and applicable coding regulations.
Communication Skill: Must have excellent communication and interpersonal skills
Working Hours: Mid shift
Work Model: Hybrid - Should be able to work from office at least for the first 6 months.
Telecommuter/Internet requirements, if applicable:
Wi-Fi with excellent bandwidth, uninterrupted power (power back up)
