Lead Assistant Manager-Auditors-DRG

EXL Service -
Chennai, Tamil Nadu

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Job details

Full-time

Qualifications

Auditing
EHR systems
Medical coding
Content management systems
Analysis skills
Bachelor's degree
CPT coding
Leadership
Billing
Communication skills

Full job description

Job Description: Medical Coding Team Lead – Surgery & Payment Integrity is responsible for overseeing a team of medical coding specialists to ensure accurate, compliant, and timely auditing of surgical procedures across multiple specialties. This role demands strong technical expertise in CPT, ICD-10, and HCPCS coding, particularly within DRG coding domains

Team Leadership & Management: Lead, mentor, and manage a team of medical coding specialists to deliver high-quality auditing outcomes. Foster a collaborative, accountable, and performance-driven team culture.

Quality & Compliance: Ensure all coding and auditing activities adhere to the latest industry standards, payer guidelines, and regulatory requirements. Conduct regular audits to maintain accuracy and compliance.

Training & Development: Provide continuous education, coaching, and feedback to the coding team to enhance their technical skills and domain expertise.

Workflow Oversight: Manage coding workflow, prioritize daily assignments, and monitor progress to ensure timely completion of audit deliverables and achievement of productivity and accuracy targets.

Regulatory Updates: Stay abreast of changes in coding guidelines, payer policies, and CMS updates. Effectively communicate these updates and their operational impact to the team.

Cross-Functional Collaboration: Partner with analytics, repricing, compliance, and quality departments to resolve coding discrepancies, streamline processes, and enhance overall audit efficiency.

Performance Monitoring: Track key performance indicators (KPIs), identify performance gaps, and develop improvement strategies to boost team productivity and quality outcomes.

Payment Integrity: Apply strong knowledge of payment integrity principles to identify claim errors, documentation deficiencies, and missed revenue opportunities, ensuring optimal claim accuracy and reimbursement.

Subject Matter Expertise: Act as a coding and auditing expert for surgical specialties, supporting physicians, clinical teams, and business stakeholders in achieving accurate and compliant documentation and coding practices

Responsibilities: Lead and manage a team of medical coding specialist ensuring accurate and timely auditing of procedures across various specialties in accordance with industry standards, guidelines and regulatory requirements.

Provide guidance, training, and mentorship to the coding team, fostering a collaborative and high-performing work environment.

Oversee the coding workflow, prioritize work assignments, and ensure productivity and quality targets are met or exceeded.

Stay updated with changes in coding guidelines, payer policies, and industry trends related to surgery coding and payment integrity process and effectively communicate these changes to the team.

Conduct regular audits and quality checks to ensure compliance with coding guidelines, accuracy of coded data, and adherence to documentation requirements.

Collaborate with other departments, such as analytics, repricing, quality, compliance to optimize coding processes and resolve coding-related issues.

Monitor key performance indicators (KPIs) and develop performance improvement initiatives to enhance auditing efficiency, accuracy, and productivity.

Apply payment integrity processes and knowledge to ensure proper coding and billing practices, identify claim and documentation errors and deficiencies, and maximize revenue capture.

Serve as a subject matter expert on multi-specialty surgery coding and payment integrity, providing guidance and support to physicians, clinical staff, and other stakeholders to ensure appropriate documentation, coding, and auditing practices

Qualifications: Bachelor’s degree in Clinical or Healthcare Information Management or a related field.
Relevant certifications (e.g. CPC,CIC,CCS for DRG) are mandatory.
Extensive experience in medical coding, with a focus on DRG coding and strong knowledge of CPT, ICD-10-CM, HCPCS coding systems.
Proficient in using coding software and electronic health record (EHR) systems.
Strong analytical and problem-solving skills, with the ability to identify coding-related issues, propose solutions, and implement process improvements.
Excellent interpersonal and communication skills, with the ability to collaborate effectively with diverse stakeholders and build positive relationships.
Detail-oriented with a commitment to accuracy and compliance with coding guidelines and regulations.
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
Demonstrated knowledge of healthcare industry regulations such as HIPAA and HITECH, and specific knowledge of CMS, Medicare, LCDs, NCDs, Medical Policies, Commercial payer processes and requirements.

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