Job Description

Experience:

  • 10–15 years of experience in US Healthcare Medical Coding, Coding Quality, Auditing, or Payment Integrity.
  • Strong experience managing coding quality programs across multiple specialties and/or complex healthcare processes.
  • Proven experience in client management, quality governance, process improvement, and operational transformation.
  • Experience with coding audits, root-cause analysis, quality analytics, performance benchmarking, and corrective action planning.
  • Experience leading large teams and mentoring coding auditors, SMEs, and quality professionals.
  • Exposure to Lean/Six Sigma, automation, analytics, and technology-enabled quality improvement initiatives is preferred. 

Responsibilities

  • Drive coding quality governance and process management to consistently meet or exceed client SLAs, quality targets, and contractual requirements.
  • Partner extensively with clients to understand coding requirements, establish quality benchmarks, define performance baselines, and set appropriate quality targets.
  • Develop and execute coding quality strategies, audit frameworks, and continuous improvement programs aligned with client and business objectives.
  • Lead root-cause analysis of coding errors and drive corrective and preventive actions to improve accuracy and reduce repeat defects.
  • Oversee quality dashboards, trend analysis, sampling methodologies, audit outcomes, and performance reporting to identify improvement opportunities.
  • Act as the key business interface between client quality/transformation teams and EXL Operations, Quality, Analytics, Technology, and Transformation teams.
  • Build strong relationships with key client stakeholders and influence decision-making through data-driven insights and quality improvement recommendations.
  • Drive standardization and adoption of coding best practices across processes, specialties, and client engagements.
  • Promote a Lean Six Sigma culture and use quality tools and methodologies to improve process efficiency, accuracy, and customer outcomes.
  • Mentor and develop quality leaders, auditors, SMEs, and Lean Six Sigma professionals to build a strong quality capability.
  • Lead quality transition and implementation activities for new processes, including requirement gathering, quality framework design, audit plan development, and implementation support.
  • Ensure coding quality programs comply with client requirements, internal governance standards, regulatory guidelines, and relevant industry/certification requirements.
  • Identify opportunities for automation, analytics, AI, and technology-enabled quality improvements in coding processes
  • Support RFP/RFI responses, solutioning, and business development initiatives by providing coding quality expertise, metrics, governance models, and transformation case studies.
  • Participate in client visits, governance forums, and executive discussions to showcase quality performance, improvement initiatives, and transformation outcomes.
  • Facilitate knowledge sharing and benchmarking of coding quality practices across EXL and the broader healthcare industry. 
  • Drive a culture of accountability, continuous improvement, and customer-centricity across the coding quality organization

Qualifications

  • Bachelor’s degree in Life Sciences, Healthcare, Nursing, or a related discipline.
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification preferred.
  • Lean Six Sigma certification (GB/BB) preferred.
  • Strong knowledge of ICD-10-CM, CPT, HCPCS, NCCI, CMS guidelines, payer policies, and applicable coding regulations. 

Communication Skill: Must have excellent communication and interpersonal skills

Working Hours: Mid shift

Work Model: Hybrid - Should be able to work from office at least for the first 6 months.

Telecommuter/Internet requirements, if applicable:

Wi-Fi with excellent bandwidth, uninterrupted power (power back up)


Job Details

Role Level: Executive-Level Work Type: Full-Time
Country: India City: Chennai ,Tamil Nadu
Company Website: http://www.exlservice.com Job Function: Quality Assurance & Control
Company Industry/
Sector:
Business Consulting and Services

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