Medical Coding Consultant
About The Position
We’re looking for an experienced and highly motivated Independent Medical Coding Consultant to help strengthen our clinical coding, billing, and revenue cycle operations. This is an exciting opportunity for a coding subject matter expert who enjoys solving complex problems, improving processes, mentoring teams, and helping shape the future of AI-assisted medical coding. In this role, you’ll work at the intersection of medical coding, revenue cycle operations, technology, and artificial intelligence, partnering with internal billing teams and the XpertDox technology team to improve accuracy, efficiency, and claim performance. The ideal consultant is detail-oriented, collaborative, and energized by the opportunity to turn coding insights into measurable operational improvements.
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 working within medical billing and revenue cycle environments.
- Familiarity with Athena or similar electronic health record/revenue cycle platforms.
- Interest or experience in AI-assisted coding, coding automation, or healthcare technology.
- Strong analytical and problem-solving skills.
- Excellent communication and collaboration skills.
- Experience developing training materials, SOPs, workflows, or staff education programs.
- The ability to translate complex coding requirements into practical guidance for billing and clinical teams.
- A strong understanding of healthcare regulatory and coding compliance requirements.
- The ability to work independently while collaborating effectively with internal teams and external technology partners.
Responsibilities
- Provide expert review and oversight of coding accuracy by reviewing and validating corrected claims prior to submission, auditing coding recommendations generated by XpertDox AI, verifying diagnosis, procedure, and modifier selection against provider documentation, identifying coding discrepancies and documentation deficiencies, and providing corrective recommendations to billing and clinical teams.
- Conduct random and targeted claim audits to measure coding accuracy and identify trends.
- Partner with XpertDox implementation and technical teams to continuously improve AI-assisted coding performance by reviewing AI-generated coding output, providing detailed feedback on coding accuracy and missed coding opportunities, identifying patterns contributing to coding errors or claim holds, participating in testing and validation of AI model enhancements, and supporting the development and refinement of coding rules, logic, and validation protocols.
- Translate real-world coding expertise into actionable recommendations for technology improvements.
- Help build a stronger, more confident billing team through practical education and ongoing coaching by training billing personnel on coding review and validation procedures, educating staff on ICD-10, CPT, HCPCS, modifiers, and documentation requirements, developing job aids, training materials, and coding reference guides, conducting workflow coaching and ongoing competency development sessions, and providing case-based learning using real-world claims examples.
- Help establish consistent coding review practices across the team.
- Evaluate current revenue cycle workflows and identify opportunities to make billing processes more efficient and effective by reviewing existing Athena revenue cycle workflows, analyzing the causes of claim holds and work queue backlogs, assessing missing slip workflows and charge capture processes, developing standardized claim review and escalation procedures, creating work queue management and prioritization processes, and recommending automation opportunities and process redesign initiatives.
- Develop practical solutions that improve workflow consistency and claim throughput.
- Take a data-driven approach to identifying and reducing preventable claim holds by analyzing historical claims hold data, categorizing and identifying root causes of claim holds, developing corrective action plans, establishing quality checkpoints before claim submission, and monitoring hold rates and improvement metrics.
- Report trends and recommendations to stakeholders.
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
