01Responsibilities
This role is accountable to ensure the converted documents are matching with the source document. Identifies discrepancies, potential quality issues and correct them manually.Research and analyse as needed.Analyses the medical policies and identifies documentation deficiencies.Assigns codes for each answer options in the decision tree.Follows coding conventions. Serves as coding consultant.Serves as resource and subject matter expert to other coding staff.Assists lead or supervisor in orienting, training, and mentoring staff.Provides ongoing training to staff as needed.Handles special projects as requested.
SKILLS & ABILITIES:
Education: MBBS / MD / foreign medical graduate background, strong English writing, ability to read medical policies, and comfort with clinical documentation. Product fit: Can explain policy rules to product managers, QA, engineers, and AI teams; can identify ambiguity, versioning needs, auditability, and human-in-the-loop review points.
Experience:
U.S. payer exposure, Medicare Advantage, Medicaid, Commercial payer, prior authorization, appeals, UM, medical necessity, HEDIS/Stars, risk adjustment, or clinical guidelines.
Must have some experience within a clinical setting and/or as an experience includes clinical research, critical thinking, time management, medical coding.
Computer Skills: Microsoft Office Suite - Word, Excel, PowerPoint, Visio, Teams, Sharepoint, Outlook, OneDrive. .
