Outpatient Certified Coding Subject Matter Expert

We are seeking a skilled Outpatient Certified Coding SME to join our Think Tank team. The ideal candidate will play a key role in identifying improperly paid healthcare claims, developing algorithm logic, and working collaboratively with operations and data analytics teams. This is a fast-paced environment where creativity, research skills and attention to detail are critical.

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 to determine the best audit candidates.
• Audit medical charts to validate claims accuracy.
• Conduct research on Medicare, Medicaid, and commercial payer payment rules and regulations.
• Collaborate with the operations and data analytics teams to ensure findings are actionable and aligned with organization goals.
• Propose innovative solutions to improve claims identification and auditing processes.

Qualifications:

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

Preferred

• Exceptional analytical and problem-solving skills.
• Strong research capabilities and creative thinking.
• Ability to work effectively in a fast-paced environment.
• Excellent communication and teamwork skills.
• Proven ability to audit charts and analyze complex healthcare claims data.
• Experience in designing and implementing logic for claim selection algorithms.
• Demonstrated track record of working collaboratively across departments.

The team is focused on innovation, efficiency, and accuracy in healthcare claims auditing and analysis. This is a full-time, fast-paced role requiring adaptability, collaboration, and a commitment to excellence. If you are passionate about improving payment accuracy and leveraging your expertise to drive meaningful change, we encourage you to apply for this exciting opportunity.

What We Offer:

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions.
• From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.