Clinical Provider Auditor II responsible for examining claims and identifying fraud risks at Elevance Health. Collaborating with internal teams and assisting in training new associates.
About the role
- Quality Auditor ensuring compliance and accuracy in medical coding for healthcare at EXL. Collaborating with coding teams and supporting education initiatives while staying updated with industry standards.
Responsibilities
- Perform detailed quality audits of coded medical records to ensure accuracy, compliance, and adherence to official coding guidelines and payer-specific requirements.
- Review and analyze clinical documentation for completeness and accuracy in assigning CPT, ICD-10-CM, and HCPCS codes.
- Identify coding errors, trends, and areas for improvement; provide actionable feedback and recommendations to the coding team.
- Collaborate with coding managers and training teams to support process improvement and coding education initiatives.
- Stay current with updates to coding standards, payer regulations, and compliance requirements.
Requirements
- Life science/Paramedical Degree
- CPC
- 7 - 12 year of Coding with quality experience
- Specialty worked: IVR – Mandatory (Must be dealt with complex level IVR coding, cardiovascular surgery and General surgery
- 5+ years of coding experience
- 2+Years of Team lead role
- CPMA certification is added advantage.
- Location –Chennai
- QC experience
Benefits
- EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates.
- Health insurance
- Retirement plans
- Paid time off
- Flexible working arrangements
- Professional development
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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