Certifications:
- CPC - Certified Professional
- CCS - Certified Coding Specialist
- CIC - Certified Inpatient Coder
- Advanced knowledge of medical coding software platforms (e.g., 3M Code Finder, Optum360, True Code, Epic, Cerner, etc.).
- Minimum 5 years of experience in Inpatient DRG coding.
- Outpatient medical coding experience is added advantage.
- Mandatory working experience on US healthcare automation projects.
- Knowledge on automation tools
- Knowledge of programming language would be added advantage alike.
- Python
- SQL
- R, etc.
- Payer experience is added advantage.
- Expertise in Microsoft outlook/excel/word/Power BI.
Primary Roles and Responsibilities:
- Automation of DRG Coding to streamline repetitive coding tasks.
- Bringing AI based solutions for DRG claims validations.
- Improve compliance through predictive analytics.
- AI-Assisted decision-making automations for diagnosis and procedure codes.
- Ability to work with physicians, IT professionals, SMEs, and medical coders.
- Solutions to automatically recognize and extract data from medical records to facilitate auditing.
- Workflows Optimization.
- Conducting UAT and providing feedback to the respective teams.
- Retraining and evaluating the performance of the automated model.
- Estimating or projecting the return on investment (ROI).
- Perform analysis of benchmarking.
Additional Roles and Responsibilities:
- Oversee operations of healthcare facilities.
- Manage staffing, scheduling, and resource allocation
- Stay updated on changes in healthcare.
- Develop and implement quality improvement initiatives.
- Strategic planning process to align organizational goals.
- Engage in market analysis to understand the competitive landscape.
- Maintaining SOP and Audit manual.
- Track key performance indicators (KPIs).
