Medical Coder

2 weeks ago

Bengaluru Chennai Hyderabad, India Tiger Analytics Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Domains Responsibility Clinical assets Support clinical coding team in the creation, update, and maintenance of clinical assets Research and bring in international and regional medical coding schemas/ classifications, crosswalks, risk adjustment tools, reference lists/ value sets and drug/ medical device directories to the database, enhancing company's medical coding assets. Create and maintain crosswalks (code mappings) matching up/ recommend the equivalent codes based on coding guidelines. Work closely with the DS team and support in New Asset ingestion into the Database Highlighting the standard's licensing requirements (wherever applied), engagements with the licensing vendor, requirement gathering & reporting.

Rules & Benefits Creation & maintenance of clinical & operational rules for fraud waste and abuse (FWA) for health insurance

Research of international and local APAC trends in FWA and available guidelines that are standard in the industry

Creation & validation of Code value sets/ Concepts/ Reference lists for claims processing, benefit rules and billing schedule lists

Clinical Coding

Data assessment & schema finalization efforts for different markets. Create and maintain Schemas and Properties to fill in for the coding gaps across different clinical domains. Annotations - Analyse and interpret claims header level & line level descriptions and other documentation, categorize them into clinical domains (E.g., Procedures, radiology, Nursing etc.) and convert them into agreeable code format. Engage & support to improve Annotations Interface.

Create and maintain Annotation Guidelines & SOPs for the team. Review and verify codes for diagnoses, procedures and treatment, and observations for coding inaccuracies and deficiencies as part of codes quality/ audit checks Actively participate in the Review committee/ Feedback sessions.

Meet and maintain established quality coding goals, ensuring accuracy and compliance with coding standard Actively participate in Code Training & Mentoring - International & regional Knowledge sharing DRG Input & Output Files clinical audit/ coding sense checks.

Provide clinical support in the analysis of claims data to derive actionable clinical insights. Engagements with internal stakeholders for any clarification, updates etc.

Comparison of different DRGs & support in writing assessment reports.

Overall Client Support

Serve as a resource and subject matter expert to other coding staff. Support Leads & Sub-leads in managing Client discussions & expectations, business priorities, performance tracking, & resource hiring. Handle confidential information appropriately, adhering to company requirements General business / Product team support

Note ** : Please note, we are looking for immediate joiners ( 0 to 20 days), anything above this timeline may not work, kindly share your interest accordingly.

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