Medical Coding Auditor-1

Veradigm Inc.; Pune District; Hybrid; INR 450,000 - 750,000; Full time

Benefits offered by this job

Recharge days

Hybrid work environment

Cheer awards

Tuition reimbursement

Job summary

Veradigm Inc. seeks experienced Medical Coders to support our enterprise coding capability. You will ensure accuracy of AI-generated medical codes, prepare charts, and draft clinical notes.

Review outputs of AI agents and compare to documentation to verify that codes are supported, billable, and accurate. This role emphasizes reasoning defensibility over high-volume processing. Flexible work options are offered (Hybrid).

Qualifications

• Review AI-generated medical codes against clinical documentation for support and billability.
• Distinguish defensible additions from unsupported inference.
• Identify over-coding and under-coding to prevent audit risk and unreimbursed care.
• Evaluate E/M level selection against documentation and CMS guidelines.
• Participate in dual review and resolve disagreements with documented rationale.
• Flag ambiguous guidance to improve grading guidelines and dataset quality.
• Apply specialty conventions, starting with internal medicine, adapting outputs accordingly.

Responsibilities

• Review AI-generated ICD-10-CM, CPT, and HCPCS codes against clinical notes, marking support and location.
• Detect over- vs under-coding to manage audit risk and reimbursements.
• Assess proper E/M level selection per CMS guidelines.
• Contribute to scoring guide improvements and ensure consistent application.
• Engage in dual reviews and document resolutions; flag ambiguities for guideline updates.
• Collaborate across specialties, beginning with internal medicine, noting documentation impacts.

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.