Outpatient Certified Coding Subject Matter Expert

EXL Service; Washington (District of Columbia); Remote; USD 100,000 - 120,000; Full time

Job summary

An established industry player is seeking a skilled Outpatient Certified Coding SME to join their innovative team. In this dynamic role, you will analyze healthcare claims, develop algorithms to identify payment inaccuracies, and collaborate with cross-functional teams to enhance auditing processes. This position offers a unique opportunity to leverage your expertise in coding and analytics while working in a supportive and growth-oriented environment. If you are passionate about improving healthcare outcomes and want to make a significant impact, this role is for you.

Benefits

Innovative work environment

Mentoring programs

Career advancement opportunities

Flexible telecommuting options

Qualifications

• 2+ years experience with ICD-10-CM and CPT/HCPCS coding.
• Current coding certification through AAPC or AHIMA.

Responsibilities

• Analyze healthcare claims to identify improper payments.
• Develop logic for algorithms to flag incorrectly paid claims.
• Audit medical charts to validate claims accuracy.

Skills

ICD-10-CM Coding

CPT/HCPCS Coding

Analytical Skills

Problem-Solving Skills

Research Skills

Communication Skills

Teamwork Skills

Education

Bachelor’s Degree in Health Information

Coding Certification (CPC, COC, RHIT, RHIA)

Job description

Outpatient Certified Coding Subject Matter Expert Atlanta, GA, USA ● Baltimore, MD, USA ● Charlotte, NC, USA ● Chicago, IL, USA ● Dallas, TX, USA ● Houston, TX, USA ● Indianapolis, IN, USA ● Jacksonville, FL, USA ● Kansas City, MO, USA ● Miami, FL, USA ● Minneapolis, MN, USA ● Nashville, TN, USA ● Oklahoma City, OK, USA ● Phoenix, AZ, USA ● Raleigh, NC, USA ● Roanoke, VA, USA ● St. Louis, MO, USA ● United States ● Washington, DC, USA ● Virtual Req #27701 Tuesday, April 29, 2025

Company Overview and Culture

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes, and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Founded in 1999, headquartered in New York, with over 55,000 employees across six continents. For more information, visit http://www.exlservice.com.

About EXL Health

We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue, and maximize profitability across the healthcare ecosystem. Our solutions are centered around technology, data, and analytics. We work closely with clients to transform how care is delivered, managed, and paid. We serve hundreds of organizations with data on over 260 million lives, focusing on improving member care quality, managing population risk, reducing administrative waste, and supporting pharmacy benefit management and provider organizations.

We seek a skilled Outpatient Certified Coding SME to join our Think Tank team. The ideal candidate will identify improperly paid healthcare claims, develop algorithm logic, and collaborate with operations and data analytics teams. This fast-paced environment demands creativity, research skills, and attention to detail.

Key Responsibilities:

• Analyze healthcare claims to identify improper payments.
• Develop logic and criteria for algorithms to flag incorrectly paid claims.
• Select claims for audit and perform in-depth analysis.
• Audit medical charts to validate claims accuracy.
• Research Medicare, Medicaid, and commercial payer rules and regulations.
• Collaborate with operations and data analytics teams to ensure actionable findings.
• Propose innovative solutions to improve claims auditing processes.

Qualifications:

• Bachelor’s degree in Health Information, Health Informatics, or related field.
• 2+ years of experience with ICD-10-CM, CPT/HCPCS coding.
• Current coding certification (e.g., CPC, COC, RHIT, RHIA) through AAPC or AHIMA.
• Strong understanding of Medicare, Medicaid, and commercial payment rules.

Preferred Skills:

• Analytical and problem-solving skills.
• Research capabilities and creative thinking.
• Ability to work effectively in a fast-paced environment.
• Excellent communication and teamwork skills.
• Experience in chart audits and complex claims data analysis.
• Experience designing logic for claim selection algorithms.
• Collaborative cross-departmental work experience.

This role requires adaptability, collaboration, and excellence. If you are passionate about improving payment accuracy through your expertise, apply now.

What We Offer:

• An innovative environment with talented professionals.
• Opportunities to learn from experienced healthcare consultants.
• Growth in teamwork and time-management skills.
• Mentoring programs with senior professionals.
• Potential for career advancement within EXL Health.

EEO/Minorities/Females/Vets/Disabilities

To view our total rewards, click here: https://www.exlservice.com/us-careers-and-benefits

Salary Range: The salary varies based on location and experience, with a typical range of $100,000 to $120,000. Other benefits include bonuses, PTO, and region-specific perks. Data sharing complies with our Privacy Policy.

Important Notices: Impersonation is illegal and will be prosecuted. AI may be used in recruiting, but final hiring decisions are made by the team. Candidates may opt out of AI screening without impact on their application.

Additional Details:

• Pay Type: Salary
• Employment: Regular
• Travel: Yes, 10%
• Telecommuting: 100%
• Education: Bachelor’s Degree required

Apply Now