Manager - Operation

EXL; Chennai; Remote; INR 1,200,000 - 1,800,000; Full time

Job summary

EXL is seeking a seasoned Lead - Medical Coding to oversee a multi-specialty surgical coding and auditing team in Chennai. The role focuses on accuracy, compliance, and timely processing of claims, leveraging CPT, ICD-10-CM, HCPCS knowledge and payer guidelines.

You will mentor staff, drive process improvements, monitor KPIs, and collaborate with Analytics, Quality, Compliance and Revenue teams to optimize coding workflows. A strong background in HIPAA/HITECH and billing integrity is essential.

Qualifications

• CPC+ with 7 years DRG coding experience.
• Bachelor's degree in health information management; CCS/CPMA/CPC certifications mandatory.
• Strong knowledge of CPT, ICD-10-CM, HCPCS and payer guidelines.
• Experience in auditing, denial management (optional).
• 40 hours per week; full-time; shift times.
• Telecommuter policy and broadband required.

Responsibilities

• Lead and manage a team of medical coding specialists for auditing of multi-specialty surgical claims.
• Provide coaching and mentorship to improve performance.
• Ensure productivity, quality, and turnaround time targets are met.
• Stay updated with coding guidelines and payer policies and communicate updates.
• Collaborate across Analytics, Repricing, Quality, and Compliance to optimize coding operations.
• Monitor KPIs and drive continuous improvement.
• Apply payment integrity principles to identify inaccuracies and revenue opportunities.
• Serve as SME for multi-specialty surgical coding and billing compliance.
• Ensure HIPAA and CMS compliance.

Skills

CPC+

Auditing

Denial Mgmt

Surgery coding

CPT/ICD-10-CM/HCPCS

Team Leadership

HIPAA Compliance

Education

Bachelor's in Health Information Management

CCS/CPMA/CPC certification

Tools

EHR Systems

Auditing Tools

Coding Software

Job description

Job Description:

• Strong expertise in multi-specialty surgical coding, auditing, and payment integrity processes.
• In-depth knowledge of ICD-10-CM, CPT, HCPCS, modifier usage, and payer-specific coding guidelines.
• Comprehensive understanding of CMS, Medicare, Medicaid, LCDs, NCDs, commercial payer policies, and reimbursement methodologies.
• Proficiency in coding software, auditing tools, and Electronic Health Record (EHR) systems.
• Strong analytical and problem-solving abilities with a focus on identifying coding discrepancies and implementing process improvements.
• Excellent leadership, coaching, and team management skills.
• Effective communication and stakeholder management skills with the ability to collaborate across departments.
• High attention to detail and commitment to coding accuracy, compliance, and quality standards.
• Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment.
• Sound knowledge of healthcare regulations, including HIPAA, HITECH, and industry compliance requirements.

Responsibilities

• Lead and manage a team of medical coding specialists, ensuring accurate and timely auditing of multi-specialty surgical claims.
• Provide coaching, training, and mentorship to enhance team performance and foster a collaborative work environment.
• Oversee coding workflows, assign priorities, and ensure productivity, quality, and turnaround time targets are consistently achieved.
• Stay current with coding guideline updates, payer policies, regulatory changes, and industry best practices, and communicate relevant updates to the team.
• Conduct regular coding audits and quality reviews to ensure compliance with coding standards, documentation requirements, and organizational policies.Collaborate with cross-functional teams, including Analytics, Repricing, Quality, and Compliance, to optimize coding operations and resolve coding-related issues.
• Monitor and analyze key performance indicators (KPIs), identify performance gaps, and implement continuous improvement initiatives.
• Apply payment integrity principles to identify coding inaccuracies, documentation deficiencies, billing errors, and revenue optimization opportunities.
• Serve as the subject matter expert (SME) for multi-specialty surgical coding and payment integrity, providing guidance to internal stakeholders and supporting accurate documentation and coding practices.
• Ensure compliance with healthcare regulations, including HIPAA, HITECH, CMS, Medicare, and commercial payer requirements.

Qualifications

Experience:

• CPC+ 7 years experience in DRG coding area

• Auditing and denial management experience (Optional)

• Extensive experience in medical coding, with a focus on surgery coding and strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.

• Qualification:

• Bachelor's degree in clinical or healthcare information management or a related field. Relevant certifications (e.g. CCS, CPC, CPMA) are mandatory.

• CommunicationSkill:

• Strong written (documentation) and oral communication skills

• Working Hours:

• 40 hours per week as Full-time employee

• Shift time: 8:00 PM IST - 5:00 PM IST

• Weekends Off

• Telecommuter/Internet requirements, if applicable:

• High Speed internet connection at home, must be broadband

• Must understand and adhere with telecommuter policy.

Requirements: