SME (Professional & Facility) --Multispecialty Surgery Coding

5 days ago

Hyderabad, India Eclat Health Solutions Full time

Multispecialty Surgery Coding – SME (Professional & Facility)

Job Summary:

We are seeking an experienced Multispecialty Surgery Coding Expert to serve as a Subject Matter Expert (SME) for both professional and facility surgery coding. The SME will provide in-depth knowledge, training, auditing, and guidance on complex surgical coding across multiple specialties, ensuring compliance with ICD-10-CM, CPT, HCPCS, CMS guidelines.

Key Responsibilities:

  • Serve as the go-to resource for multispecialty surgical coding questions (professional and facility).
  • Perform accurate coding for complex surgical procedures across multiple specialties, including orthopedic, cardiovascular, neurological, digestive, urology, general surgery, IVR and transplant cases.
  • Review operative reports, anesthesia notes, and other clinical documentation to ensure correct code assignment.
  • Provide training, mentoring, and support to coders and auditors on complex surgical scenarios.
  • Conduct audits, root cause analysis, and compliance reviews to identify coding/documentation gaps.
  • Stay updated on official coding guidelines (CMS, AHA Coding Clinic, CPT Assistant, OIG, and payer-specific policies).
  • Develop best practices, SOPs, and workflow improvements for professional and facility surgery coding.

Qualifications & Skills:

  • Certification: CPC, CCS, CIC, or COC required (CCDS or CCDS-O preferred).
  • Experience: Minimum 5+ years of multispecialty professional and facility coding experience, with a strong focus on surgical coding.
  • Excellent knowledge of NCCI edits, modifiers, and payer-specific guidelines.
  • Prior experience as an SME, trainer, or auditor in coding operations preferred.
  • Strong analytical, problem-solving, and communication skills.
  • Proficiency in 3M , Optum, Encoder, or other leading HIM/coding applications.

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