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Kompaniyadagi ish o‘rinlari

Medical Coding Audit Manager – Pune, India (Hybrid)

Lead Veradigm’s medical coding evaluation function and distributed team of certified coders. Set clinical scoring standards, audit AI-generated coding for accuracy, and report quality and risk metrics to stakeholders.

INHindistonGibridTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaTibbiy hisob-kitob va kodlash

Tavsif

  • Oversee daily operations for Veradigm’s Medical Coding Evaluation team supporting enterprise coding programs
  • Assess AI-generated coding against clinical documentation to verify code support, billability, and accuracy
  • Create and maintain scoring guidance in partnership with clinical specialists
  • Assign reviewers and manage priorities, capacity, and evaluation throughput
  • Resolve disagreements between reviewers and record the supporting rationale
  • Monitor agreement among reviewers and improve evaluation guidance as needed
  • Lead calibration exercises and assess readiness for scaled evaluations
  • Present clinical performance, accuracy, claims inclusion, and risk-effect metrics to leadership, product teams, and clients
  • Develop specialty coverage plans, starting with internal medicine
  • Broaden evaluation activities to include chart preparation and clinical note quality
  • Test automated scoring through sample reviews and report differences from expert assessments
  • Organize evaluations with design partners
  • Apply approved data-access limits, authorized data tiers, and compliant review tools
  • Recruit, mentor, and develop a distributed team of certified coders

Talablar

  • Bachelor’s degree in health information management, healthcare administration, or comparable technical or business experience
  • At least 8 years of relevant experience, including 2–3 years at expert level or equivalent experience preferred
  • Four years of ICD-10-CM, CPT, and HCPCS coding across multiple specialties, with strong attention to detail and consistently high accuracy
  • Two years of coding audit or coding quality-review experience
  • Two years of outpatient or ambulatory coding experience in a multispecialty or large-group practice
  • One year developing coding guidelines, audit criteria, or annotation standards for use by other reviewers
  • One year reviewing automated or computer-assisted coding output or performing comparable structured annotation work
  • Medicare Risk Adjustment or HCC coding experience preferred
  • Two to four years of relevant leadership experience, preferably managing distributed or remote teams
  • Active CPC, CCS, or CCS-P certification through AAPC or AHIMA required
  • CPMA certification preferred
  • CRC certification preferred
  • Expert knowledge of medical coding, including ICD-10-CM, CPT, HCPCS Level II, modifiers, E/M documentation guidelines, and CMS claims-processing rules
  • Ability to create clear, unambiguous evaluation criteria that reviewers can apply consistently
  • Working knowledge of inter-rater agreement, sampling methods, and distinguishing reviewer error from unclear guidance
  • Ability to explain coding decisions to engineers and product managers and translate technical questions into coding terminology
  • Sound judgment when documentation is incomplete or coding guidance is unclear
  • Demonstrated ability to lead distributed teams across locations or time zones
  • Ability to work independently with limited supervision
  • Working knowledge of HIPAA privacy and security requirements for clinical and de-identified data
  • Availability for periodic overlap with United States time zones
  • Willingness to travel up to 10%

Imtiyozlar

  • Quarterly company-wide recharge days
  • Flexible hybrid work environment
  • Peer-nominated “Cheer” incentive awards
  • Tuition reimbursement program

O‘xshash ish o‘rinlari

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