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 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 & 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)