Senior Executive - Coding Auditor

• Perform accurate CPT / ICD-10-CM coding with appropriate modifier usage
• Review and analyze denied claims and identify root causes
• Initiate outbound calls to provider offices for denial clarification and resolution
• Document call outcomes and update claim status in systems
• Ensure timely follow-up on pending claims to maximize reimbursement
• Adhere to client-specific guidelines and project requirements
• Maintain quality and productivity benchmarks as defined by the client
• Prepare reports and track performance using MS Excel / PPT

• Perform accurate CPT / ICD-10-CM coding with appropriate modifier usage
• Review and analyze denied claims and identify root causes
• Initiate outbound calls to provider offices for denial clarification and resolution
• Document call outcomes and update claim status in systems
• Ensure timely follow-up on pending claims to maximize reimbursement
• Adhere to client-specific guidelines and project requirements
• Maintain quality and productivity benchmarks as defined by the client
• Prepare reports and track performance using MS Excel / PPT

Qualifications & Skills (8–10 Points)

• Denial Experience (EM + Surgery) and 3+ Years after CPC/CCS is not mandatory
• Strong knowledge of CPT, ICD-10-CM, modifiers, E&M, and surgical coding
• Good understanding of Anatomy & Physiology
• Mandatory certification: CPC or CCS (No Apprentice credentials)
• Excellent communication skills with neutral accent (mandatory for calling role)
• Prior experience in voice process is an added advantage
• Ability to work in Eastern (US) shift
• High energy level with proactive and spontaneous approach
• Strong analytical and problem-solving skills
• Proficiency in MS Office (Excel & PowerPoint)
• Ability to understand client requirements and deliver accordingly
  
  Telecommuting Requirement
• Must be comfortable working in a telecommuting (remote/hybrid) setup as per business requirements
• Ensure stable internet connectivity and a distraction-free work environment for both coding and calling responsibilities q