Senior Medical Coder(with FWA experience) WFH/DAYSHIFT

Responsibilities:

• Team’s point of contact for the given market for clients as well as AH product team
• Potential to actively contribute, guide and review a small coding team of 2 to 5 people
• Operate quite independently as an individual contributor.
• Perform reviews on others work
• Performing validations in addition to the contributing to underlying delivery
• Perform broader assessments on the landscape to assess viability of assets/rules/benefits/coding in certain markets and data
• Creation & maintenance of clinical & operational rules for fraud waste and abuse (FWA) for health insurance
• Research of international and local APAC trends in FWA and available guidelines that are standard in the industry
• Creation & validation of Code value sets/ Concepts/ Reference lists for claims processing, benefit rules and billing schedule list

• At least 7 years of relevant experience
• Experience in Rules & Benefits Development (FWA detection, claims processing, billing schedules)
• Experience Reference Data Management (Value sets, Concepts, Reference lists)
• Experience Data Validation & Review (audits, peer review, quality checks)
• Experience Research & Trend Analysis (APAC & global FWA guidelines, coding standards)
• Experience Team Leadership & Guidance (mentoring, small team management, client point of contact)
• Experience Stakeholder Engagement & Communication (cross-functional collaboration, reporting)
• Experience in landscape assessments for viability of assets/rules/benefits/coding in markets & data
• Medical Coder Certification