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Outpatient Certified Coding Subject Matter Expert - Minneapolis Minnesota
Company: EXL Service
Location: Minneapolis, Minnesota
Posted On: 05/09/2025
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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