Sr Medical Coding Auditor

LE9220 Veradigm India Private Limited - Pune; Pune District; Hybrid; INR 600,000 - 900,000; Full time

Benefits offered by this job

Quarterly Company-Wide Recharge Days

Flexible Work Environment (Hybrid)

Tuition Reimbursement Program

Peer-based incentive “Cheer” awards

Job summary

Veradigm is seeking experienced Medical Coders to support enterprise coding capabilities in Pune. You will review AI-generated ICD-10-CM, CPT, and HCPCS codes against clinical documentation to ensure accuracy, defensibility, and billability.

The role emphasizes quality over volume and requires collaboration across specialties, starting with internal medicine. Responsibilities include dual reviews, identifying coding gaps, and helping refine scoring guides while communicating findings to

Qualifications

• Experience in medical coding and chart review.
• Knowledge of ICD-10-CM, CPT, HCPCS coding systems.
• Familiarity with CMS guidelines and E/M level evaluation.

Responsibilities

• Review AI-generated codes against clinical documentation and judge support.
• Identify over- and under-coding risks.
• Evaluate E/M level selection per CMS guidelines.
• Participate in dual reviews and resolve disagreements.
• Explain patterns to ML engineers and product managers.

Skills

Medical coding

ICD-10-CM

CPT

HCPCS

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.