Medical Coding Consultant - On-Site

Bms-Family-Health-and-Wellness-Centers-; New York (NY); Presencial; USD 90 000 - 130 000; Tempo integral

Resumo da oferta

Bms-Family-Health-and-Wellness-Centers- seeks an Independent Medical Coding Consultant to strengthen clinical coding, AI-assisted coding, and revenue cycle performance. You will bridge operations, technology, and billing teams to improve accuracy, claims processing, and reduce denials.

The role focuses on validating coding, mentoring teams, and collaborating with XpertDox and Athena to optimize workflows, coding rules, and QA while ensuring regulatory compliance.

Qualificações

• Strong knowledge of medical coding including ICD-10, CPT, HCPCS, modifiers and documentation requirements.
• Experience with coding validation, auditing, and claim correction.
• Experience in medical billing and revenue cycle environments.
• Familiarity with Athena or similar EHR/RR platforms.
• Interest or experience in AI-assisted coding or healthcare technology.

Responsabilidades

• Review and validate corrected claims prior to submission.
• Audit AI-generated coding recommendations and provide feedback on accuracy and missed opportunities.
• Train billing personnel on coding validation procedures and develop training materials.
• Evaluate Athena revenue cycle workflows and identify optimization opportunities.
• Develop SOPs, workflows, and staff education programs to improve accuracy and throughput.

Conhecimentos

ICD-10

CPT

HCPCS

Modifiers

Documentation

Auditing

AI-assisted coding

Ferramentas

Athena EHR/Revenue Cycle Platform

XpertDox

Descrição da oferta de emprego

Description

Make an Impact on Coding Accuracy, AI Innovation & Revenue Cycle Performance

We're looking for an experienced and highly motivated Independent Medical Coding Consultant to help strengthen our clinical coding, billing, and revenue cycle operations.

This is an exciting opportunity for a coding subject matter expert who enjoys solving complex problems, improving processes, mentoring teams, and helping shape the future of AI-assisted medical coding. In this role, you'll work at the intersection of medical coding, revenue cycle operations, technology, and artificial intelligence, partnering with internal billing teams and the XpertDox technology team to improve accuracy, efficiency, and claim performance.

The ideal consultant is detail-oriented, collaborative, and energized by the opportunity to turn coding insights into measurable operational improvements.

About the Role

The Independent Medical Coding Consultant will provide subject matter expertise in clinical coding validation, AI-assisted coding optimization through XpertDox, and billing workflow improvement within Athena.

You will serve as a key liaison between operational billing staff and the coding technology vendor, helping identify opportunities to improve coding accuracy, accelerate claims processing, reduce claim holds and coding-related denials, and strengthen overall revenue cycle performance.Key Objectives

In this role, you will help us:

• Validate corrected medical claims and coding recommendations generated through XpertDox.
• Improve AI-assisted coding accuracy through feedback, testing, and training.
• Build internal billing team expertise in coding validation and claim correction.
• Reduce claim holds, missing slips, and coding-related claim denials.
• Establish standardized coding validation, workflow, and quality assurance processes within Athena.
• Improve billing efficiency and claim throughput while maintaining regulatory and coding compliance.

Key Responsibilities

1. Coding Validation & Quality Assurance

You will provide expert review and oversight of coding accuracy by:

• Reviewing and validating corrected claims prior to submission.
• Auditing coding recommendations generated by XpertDox AI.
• Verifying diagnosis, procedure, and modifier selection against provider documentation.
• Identifying coding discrepancies and documentation deficiencies.
• Providing corrective recommendations to billing and clinical teams.
• Conducting random and targeted claim audits to measure coding accuracy and identify trends.

Key Deliverables:

• Coding validation reports
• Monthly audit findings and trend reports
• Coding error tracking log
• Process improvement recommendations

2. XpertDox AI Optimization & Vendor Collaboration

Partner with XpertDox implementation and technical teams to continuously improve AI-assisted coding performance.

Responsibilities include:

• Reviewing AI-generated coding output.
• Providing detailed feedback on coding accuracy and missed coding opportunities.
• Identifying patterns contributing to coding errors or claim holds.
• Participating in testing and validation of AI model enhancements.
• Supporting the development and refinement of coding rules, logic, and validation protocols.
• Translating real-world coding expertise into actionable recommendations for technology improvements.

Key Deliverables:

• AI performance assessment reports
• Coding correction and feedback logs
• User acceptance testing documentation
• Recommendations for AI training and performance improvements

3. Billing Team Education & Knowledge Development

Help build a stronger, more confident billing team through practical education and ongoing coaching.

You will:

• Train billing personnel on coding review and validation procedures.
• Educate staff on ICD-10, CPT, HCPCS, modifiers, and documentation requirements.
• Develop job aids, training materials, and coding reference guides.
• Conduct workflow coaching and ongoing competency development sessions.
• Provide case-based learning using real-world claims examples.
• Help establish consistent coding review practices across the team.

Key Deliverables:

• Training curriculum
• Standard operating procedures (SOPs)
• Billing reference guides
• Monthly training sessions
• Staff competency assessments

4. Athena Workflow Assessment & Optimization

Evaluate current revenue cycle workflows and identify opportunities to make billing processes more efficient and effective.

You will:

• Review existing Athena revenue cycle workflows.
• Analyze the causes of claim holds and work queue backlogs.
• Assess missing slip workflows and charge capture processes.
• Develop standardized claim review and escalation procedures.
• Create work queue management and prioritization processes.
• Recommend automation opportunities and process redesign initiatives.
• Develop practical solutions that improve workflow consistency and claim throughput.

Key Deliverables:

• Current-state workflow assessment
• Future-state workflow design
• Athena work queue optimization recommendations
• Workflow maps and SOP documentation

5. Claims Hold Reduction Initiative

Take a data-driven approach to identifying and reducing preventable claim holds.

You will:

• Analyze historical claims hold data.
• Categorize and identify root causes of claim holds.
• Develop corrective action plans.
• Establish quality checkpoints before claim submission.
• Monitor hold rates and improvement metrics.
• Report trends and recommendations to stakeholders.

Key Deliverables:

• Claims hold reduction strategy
• Root cause analysis report
• KPI dashboard
• Monthly performance review

Requirements

What We're Looking For

We're seeking a seasoned medical coding professional who brings both technical coding expertise and a continuous-improvement mindset. The ideal consultant will have:

• Strong knowledge of medical coding, including ICD-10, CPT, HCPCS, modifiers, and documentation requirements.
• Demonstrated experience with coding validation, auditing, and claim correction.
• Experience working within medical billing and revenue cycle environments.
• Familiarity with Athena or similar electronic health record/revenue cycle platforms.
• Interest or experience in AI-assisted coding, coding automation, or healthcare technology.
• Strong analytical and problem-solving skills.
• Excellent communication and collaboration skills.
• Experience developing training materials, SOPs, workflows, or staff education programs.
• The ability to translate complex coding requirements into practical guidance for billing and clinical teams.
• A strong understanding of healthcare regulatory and coding compliance requirements.
• The ability to work independently while collaborating effectively with internal teams and external technology partners.

Why This Opportunity Matters

This role goes beyond reviewing codes. You'll have the opportunity to shape how people, processes, and technology work together to improve the entire claims lifecycle. Your expertise will directly contribute to:

• More accurate coding
• Fewer preventable claim holds and denials
• Faster claims processing
• Stronger billing team capabilities
• Better use of AI-assisted coding technology
• More consistent revenue cycle workflows
• Improved operational efficiency

If you're a medical coding expert who enjoys solving problems, improving systems, coaching teams, and exploring how technology can transform healthcare operations, we'd love to hear from you.