Coding Subject Matter Expert Consultant

Coding Subject Matter Expert Consultant

• 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.).
• 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.
• 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.
• 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.
• 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.
• 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.