LSHC Outpatient Coding Analyst

Overview

This role involves conducting detailed coding and billing compliance reviews of medical records to ensure the accuracy of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes. Reviews cover diverse specialties including inpatient, outpatient, professional services, and Medicare Advantage settings. The coder will assess medical documentation for missed clarification or coding chances, using a variety of authoritative resources such as the Official Coding Guidelines, Federal and State regulations, AHA coding guidelines including Coding Clinic, AMA's CPT Assistant, and AHIMA query protocols.

Key Responsibilities

• Perform quality reviews of coding and billing for outpatient and professional medical encounters, verifying diagnoses, procedures, modifiers, and payment details.
• Examine medical documentation to find missed coding opportunities, clarify documentation gaps, and assess medical necessity.
• Evaluate the appropriateness and compliance of clinical documentation queries raised by coders.
• Conduct research on coding and billing regulations, payer policies, and industry standards to back review conclusions.
• Document rationales in writing, manage assigned workload, report outcomes to stakeholders, and assist in training and mentoring initiatives.

About the Team

This role is part of a Regulatory Healthcare Practice team focused on delivering coding and billing compliance solutions to clients, helping them address regulatory and operational risks across diverse industries. The team supports clients in navigating challenges to improve resilience and performance.

Work Details

Location: Hyderabad, Telangana, India
Shift Timings: Either 11 AM to 8 PM or 2 PM to 11 PM

Required Qualifications

• Minimum of 2 years auditing experience in complex outpatient, hospital outpatient, and professional coding and US healthcare claims.
• Active professional coding credential from AHIMA or AAPC, e.g., CCS, CPC, or CIC.
• Experienced in designing and running risk management and compliance programs.
• Familiarity with electronic medical record (EMR) systems such as Cerner, Allscripts, MDAudit, or Meditech.
• Proficient with hospital coding encoder software like Epic, 3M, and Triode.
• Knowledgeable about institutional and professional billing rules, reimbursement methods, and CMS guidelines.

Preferred Qualifications

• Experience in risk, quality, and compliance transformation programs.
• Ability to utilize data analytics to support risk and compliance activities.
• Previous consulting experience.
• Academic background in medicine or allied healthcare fields.

Additional Information

Deloitte aims to create meaningful impact for clients, employees, and communities through an inclusive culture fostering unique perspectives and innovation. Their commitment to professional development is embodied in dedicated leadership centers and comprehensive training programs. Competitive benefits support mental, physical, and financial well-being of employees and their families.