Medical Coding Auditor-1

LE9220 Veradigm India Private Limited - Pune; Pune District; Hybrid; INR 400,000 - 600,000; Full time

Benefits offered by this job

Quarterly Company-Wide Recharge Days

Flexible Work Environment (Hybrid)

Peer-based incentive “Cheer” awards

Tuition Reimbursement Program

Job summary

Veradigm India Private Limited recruits experienced Medical Coders to ensure accuracy of AI-generated codes across ICD-10-CM, CPT, and HCPCS against clinical documentation.

You will participate in coding evaluation, dual reviews, and contribute to guidelines and metrics reported to customers, with a focus on defensibility and quality rather than volume. This role emphasizes analytical thinking and cross-specialty work, starting with internal medicine, with a hybrid work setup.

Qualifications

• Experience reviewing AI-generated ICD-10-CM, CPT, HCPCS codes against clinical docs.
• Ability to distinguish defensible coding from unsupported inference.
• Familiarity with CMS guidelines for E/M level selection.

Responsibilities

• Review AI-generated code sets against clinical documentation and mark support.
• Identify over- and under-coding to reduce audit risk.
• Evaluate E/M level selections per CMS guidelines.
• Collaborate in dual reviews to resolve disagreements.
• Flag ambiguous scoring guide entries for correction.

Skills

Medical coding

ICD-10-CM

CPT coding

HCPCS coding

CMS guidelines

Job description

Position Summary

Veradigm is seeking experienced Medical Coders to support our enterprise coding capability. Applicants will focus on ensuring accuracy in AI-generated medical codes, chart preparation, and drafting clinical notes. You will review the outputs of AI agents and compare to clinical documentation, to ensure that codes are supported, billable, and accurate. Coders will also shape the guidelines we use and help define clinical metrics we report to customers. This is a role where you will use your experience and critical thinking skills to improve systems. It is not a standard coding position; you will not handle billing, provider education, or denials. The consistency and defensibility of your reasoning are prioritized over high-volume processing.

Key Responsibilities

Coding Evaluation

• Review AI-generated ICD-10-CM, CPT, and HCPCS code sets against the clinical documentation, recording for each code whether the note supports it and where.
• Distinguish clinically defensible additions from unsupported inference.
• Identify both over-coding, which creates audit risk, and under-coding, which leaves care unreimbursed.
• Evaluate E/M level selection, including correct setting and visit type, against documentation and applicable CMS guidelines.
• Apply and improve the scoring guide consistently from the first case to the hundredth.
• Participate in dual review, independently scoring the same encounter as another reviewer and working through disagreements to a documented resolution.
• Flag cases where the scoring guide is ambiguous or silent rather than resolving them quietly, so the guide can be corrected before the ambiguity spreads through the dataset.
• Work across specialties, beginning with internal medicine, applying specialty-specific conventions and noting where documentation patterns change how output should be judged.

Beyond Coding

• Review outputs that providers flag as incorrect in our products, determining whether the flag reflects a genuine agent error, a documentation gap, or a difference in provider preference.
• Help validate automated scoring systems by reviewing a sample of cases an automated judge has already scored, so we can measure where it agrees with expert judgment.
• Explain patterns in agent errors to machine learning engineers and product managers in terms they can act on, escalating systemic issues rather than scoring the same error repeated, and give feedback where the review tool slows accurate review.

Benefits

• Quarterly Company-Wide Recharge Days
• Flexible Work Environment (Hybrid)
• Peer-based incentive “Cheer” awards
• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: https://veradigm.com/about-veradigm/careers/benefits/ https://veradigm.com/about-veradigm/careers/culture/ #LI-SL1 #LI-Hybrid

Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

Welcome to Veradigm, where our Mission is transforming health, insightfully.

Join the Veradigm team and help solve many of today’s healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve.

At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.