Outpatient Certified Coding Subject Matter Expert

Company: EXL Service
Location: Minneapolis
Posted on: April 23, 2025

Job Description:

Thursday, February 20, 2025We 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 organizational 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 Qualifications:
• 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.
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Keywords: EXL Service, Minneapolis , Outpatient Certified Coding Subject Matter Expert, Other , Minneapolis, Minnesota