Job Description – Coding Subject Matter Expert Consultant
1. Coding Quality Assurance & Audit
- Perform regular and random coding quality audits on work completed by frontline coders.
- Identify errors, trends, and root causes, and provide actionable feedback to coders.
- Develop audit tools, checklists, and reporting dashboards to track performance.
- Ensure compliance with ICD-10, CPT, HCPCS, payer-specific, and federal guidelines (CMS, OIG, etc.).
2. Training & Development
- Conduct training sessions on specialty-specific coding (CPT, ICD-10, modifiers, NCCI edits, payer rules).
- Train coders on general best practices including documentation review, coding ethics, and compliance.
- Develop training materials, manuals, and knowledge repositories for ongoing skill enhancement.
- Mentor new coders and provide refresher training based on audit findings.
3. Clinical Documentation Improvement (CDI)
- Collaborate with providers to improve clinical documentation quality and completeness.
- Educate providers on documentation requirements that support coding accuracy and risk adjustment (HCC, RAF).
- Identify documentation gaps and recommend corrective actions.
- Participate in provider feedback loops to align clinical notes with coding compliance.
4. Stakeholder Collaboration
- Attend regular meetings with providers, U.S. client teams, and internal leadership.
- Partner with the Compliance Team to implement updated coding guidelines and compliance programs.
- Liaise with revenue cycle teams to align coding with billing, denial management, and reimbursement goals.
5. Compliance & Best Practices
- Monitor and interpret updates from CMS, AMA, AAPC, AHIMA, and payer bulletins.
- Establish and enforce coding policies, SOPs, and compliance standards.
- Support internal and external audits by ensuring readiness and documentation availability.
- Act as the coding escalation point for complex or disputed cases.
6. Continuous Improvement & Innovation
- Recommend process improvements to enhance coding accuracy and efficiency.
- Collaborate with technology/automation teams to integrate coding tools, AI-assisted coding, and compliance checks.
- Track KPIs such as accuracy %, audit scores, coder productivity, and denial trends.
- Support implementation of corrective action plans based on audit results.
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