Conducts coding and billing compliance reviews on medical records to validate the ICD-10-CM and ICD-10-PCS codes, CPT and HCPCS codes for various specialty (including but not limited to Inpatient, outpatient, professional and Medicare advantage setting). The review of the medical documentation is conducted to identify additional missed provider documentation clarifications and/or missed coding opportunities. The professional will utilize the following resources to perform the reviews (not inclusive): The Official Coding Guidelines, ICD-10-CM/PCS, CPT and HCPCs coding guidelines, Federal and State regulations, the American Hospital Association (AHA) coding guidelines including the Coding Clinic and American Medical Association’s (AMA) CPT Assistant publications and American Health Information Association (AHIMA) compliant query guidelines.
Work you'll do
As an Senior Consultant or equivalent on the Regulatory Healthcare Practice team, you will be responsible for supporting coding and billing compliance reviews, identifying documentation and coding opportunities, and helping clients address regulatory and operational challenges.
- Perform coding and billing quality reviews for outpatient and professional encounters to validate diagnosis, procedure, modifier, and payment accuracy.
- Review medical documentation to identify missed coding opportunities, missed documentation clarification opportunities, and medical necessity considerations.
- Evaluate coder-generated clinical documentation queries for appropriateness and compliance with applicable guidance.
- Research coding and billing regulations, payer requirements, and industry standards to support review findings and recommendations.
- Prepare written rationales, track assigned work, report findings to stakeholders, and support training, mentoring, and education efforts.
The team
Deloitte’s Risk & Financial Advisory provides you an opportunity to gain valuable hands-on experience working alongside leading professionals across diverse industries while building your professional skills in a variety of project experiences. Our Deloitte Risk & Financial Advisory practice helps organizations effectively navigate business risks and opportunities—from strategic, reputation, and financial risks to operational, cyber, and regulatory risks—to gain competitive advantage. We apply our experience in ongoing business operations and corporate lifecycle events to help clients become stronger and more resilient. Our market-leading team’s help clients embrace complexity to accelerate performance, disrupt through innovation, and lead in their industries.
Location: Hyderabad
Shift Timings: 11 AM to 8 PM / 2 PM to 11 PM
Qualifications
Required:
- 8+ years of experience auditing complex outpatient, hospital outpatient, and professional coding and US healthcare claims
- Active coding certification from the American Health Information Management Association (AHIMA) and/or the American Academy of Professional Coders (AAPC), such as CCS, CPC, or CIC
- Experience designing, implementing, and operating risk management and compliance activities
- Experience using electronic medical record systems such as Cerner, Allscripts, MDAudit, and Meditech
- Experience using hospital coding encoder tools such as Epic, 3M, and Triode
- Knowledge of institutional and professional claims, billing rules, reimbursement methodologies, and Centers for Medicare & Medicaid Services (CMS) guidelines
Preferred:
- Experience participating in risk, quality, and compliance transformation programs
- Experience using data and analytics to support risk management, quality, and compliance activities
- Prior consulting experience
- Degree in medicine or an allied healthcare field