Medical Coding Consultant - On-Site
About The Position
The Independent Medical Coding Consultant provides subject matter expertise in clinical coding validation, AI-assisted coding optimization through XpertDox, and billing workflow improvement within Athena. The consultant works with internal billing teams and the XpertDox technology team to improve coding accuracy, claims processing, claim-hold and denial reduction, and revenue cycle performance. The role combines coding quality assurance, AI output review and testing, billing team education, Athena workflow assessment, and data-driven claims-hold reduction. The consultant audits claims and coding recommendations, verifies diagnoses, procedures, and modifiers against provider documentation, identifies discrepancies and documentation deficiencies, and provides corrective guidance. They also help develop training, standard procedures, quality checkpoints, workflow designs, and performance reporting while maintaining regulatory and coding compliance.
Requirements
- Strong knowledge of medical coding, including ICD-10, CPT, HCPCS, modifiers, and documentation requirements.
- Demonstrated experience with coding validation, auditing, and claim correction.
- Experience in medical billing and revenue cycle environments.
- Strong analytical and problem-solving skills.
- Excellent communication and collaboration skills.
- Ability to translate complex coding requirements into practical guidance for billing and clinical teams.
- Strong understanding of healthcare regulatory and coding compliance requirements.
- Ability to work independently and collaborate effectively with internal teams and external technology partners.
Nice To Haves
- Familiarity with Athena or similar electronic health record or revenue cycle platforms.
- Interest or experience in AI-assisted coding, coding automation, or healthcare technology.
- Experience developing training materials, SOPs, workflows, or staff education programs.
Responsibilities
- Review and validate corrected medical claims before submission.
- Audit XpertDox AI-generated coding recommendations and assess coding accuracy.
- Verify diagnosis, procedure, and modifier selections against provider documentation.
- Identify coding discrepancies and documentation deficiencies and provide corrective recommendations to billing and clinical teams.
- Conduct targeted and random claim audits, track coding errors, and report accuracy trends.
- Provide detailed feedback on AI-generated coding output and identify missed coding opportunities and patterns contributing to errors or claim holds.
- Participate in testing and validation of AI model enhancements and support refinement of coding rules, logic, and validation protocols.
- Train billing personnel on coding review and validation procedures, including ICD-10, CPT, HCPCS, modifiers, and documentation requirements.
- Develop training curricula, job aids, reference guides, standard operating procedures, and case-based learning materials.
- Coach staff and conduct ongoing competency development and assessments.
- Review Athena revenue cycle workflows and analyze claim holds, work queue backlogs, missing-slip workflows, and charge capture processes.
- Develop standardized claim review, escalation, work queue management, and prioritization processes.
- Recommend automation opportunities, process redesign, and practical workflow improvements.
- Analyze historical claims-hold data, categorize root causes, and develop corrective action plans and quality checkpoints.
- Monitor hold rates and improvement metrics and report trends and recommendations to stakeholders.
- Prepare coding validation reports, audit findings, AI performance assessments, workflow documentation, KPI reporting, and process improvement recommendations.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
