Manager
EXL
Senior · Leadfull-time🇮🇳 India
Posted: 3 hours agoSource: fa-ewjt-saasfaprod1.fa.ocs.oraclecloud.com
Senior Manager
EXL
full-time
Posted on:
Location Type: Hybrid
Location: Noida • 🇮🇳 India
Visit company websiteJob Level
Senior
About the role
- Lead strategic initiatives to ensure accurate and appropriate healthcare payments
- Leverage advanced medical coding analysis, enforce policy adherence, and drive overpayment recovery programs
- Identify and implement automation and digitalization opportunities to streamline coding processes and enhance efficiency
- Design and lead initiatives to optimize claims processing and detect fraud, waste and abuse
- Explore and implement AI/ML solutions for fraud detection and claim validation
- Prepare and present reports on findings, opportunities and financial impacts to leadership
- Lead and mentor teams of SMEs, AMs and Managers; conduct performance reviews and training
- Collaborate cross-functionally with clinical operations, coding operations, quality, repricing, training, digital, IT and technology
- Interface with onshore teams and clients to resolve disputes and explain audit findings
- Analyze large data sets to detect aberrant payment and coding patterns; maintain SOPs and audit manuals
- Oversee Think team and payment integrity operations; manage staffing, scheduling and resource allocation
- Track KPIs and drive quality improvement and strategic planning processes
Requirements
- Bachelor’s Degree (B.Sc/M.Sc./Nursing/Pharmacy/Biotech)
- CPC/COC (Certified Professional/Outpatient Coder) certification
- CCS (Certified Coding Specialist) certification
- CIC (Certified Inpatient Coder) certification
- 12 to 18 years’ experience in medical coding, auditing and automation (minimum 12 years)
- Advanced knowledge of medical coding software platforms (3M Code Finder, Optum360, True Code, Epic, Cerner)
- Minimum 12 years of hands-on experience in multispecialty medical coding
- Knowledge of automation tools (added advantage)
- Payer experience (added advantage)
- Expertise in Microsoft Outlook, Excel, Word, Power BI
- Analytical skills
- Team management and program management (TAT, escalations, Quality)
- Strategic thinking, decision making and cost management (GM, GC, RPE)
Benefits
- Hybrid work arrangement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical codingauditingautomationdata analysisclaims processingfraud detectionAI solutionsML solutionspayment integrityKPI tracking
Soft skills
leadershipmentoringcollaborationstrategic thinkingdecision makinganalytical skillsprogram managementteam managementcommunicationtraining
Certifications
CPCCOCCCSCIC