Job Description

:
& Skills Requirements
Job Name:
Manager
Position Title:
Manager
Coding Audit Automation
Band:
C1
ERP Full Position ID:
Reporting to:
Sr Manager
Location/Site:
EXL India
Overview: Manager is responsible for identifying automation and digitalization opportunities in in-patient coding streamline processes, enhance efficiency, and reduce manual efforts through innovative technology and AI solutions aligned with organizational goals.
Qualifications: Bachelors Degree B.sc/M.Sc./Nursing/Pharmacy/Biotech
Certifications: * CPC - Certified Professional

• CCS - Certified Coding Specialist
• CIC - Certified Inpatient Coder

Experience:
Manager: 10 to 15 years experience in medical coding, auditing and automation.
Skills and Abilities: * Advanced knowledge of medical coding software platforms (e.g., 3M Code Finder, Optum360, True Code, Epic, Cerner, etc.).

• Minimum 5 years of experience in Inpatient DRG coding.
• Outpatient medical coding experience is added advantage.
• Mandatory working experience on US healthcare automation projects.
• Knowledge on automation tools
• Knowledge of programming language would be added advantage alike.
• Python
• SQL
• R, etc.
• Payer experience is added advantage.
• Expertise in Microsoft outlook/excel/word/Power BI.

Primary Roles and Responsibilities:

• Automation of DRG Coding to streamline repetitive coding tasks.
• Bringing AI based solutions for DRG claims validations.
• Improve compliance through predictive analytics.
• AI-Assisted decision-making automations for diagnosis and procedure codes.
• Ability to work with physicians, IT professionals, SMEs, and medical coders.
• Solutions to automatically recognize and extract data from medical records to facilitate auditing.
• Workflows Optimization.
• Conducting UAT and providing feedback to the respective teams.
• Retraining and evaluating the performance of the automated model.
• Estimating or projecting the return on investment (ROI).
• Perform analysis of benchmarking.

Additional Roles and Responsibilities:

• Oversee operations of healthcare facilities.
• Manage staffing, scheduling, and resource allocation
• Stay updated on changes in healthcare.
• Develop and implement quality improvement initiatives.
• Strategic planning process to align organizational goals.
• Engage in market analysis to understand the competitive landscape.
• Maintaining SOP and Audit manual.
• Track key performance indicators (KPIs).