Clinical Coder

Job Summary:

The Medical Coder is responsible for overseeing accurate and compliant medical coding practices, ensuring data integrity, and supporting rule and benefit development for claims processing and fraud, waste, and abuse (FWA) detection. This role involves managing coding schemas, conducting quality audits, and collaborating with cross-functional teams to align with ICD-10-CM, ICD-10-PCS, CPT, and HCPCS standards. The ideal candidate has extensive experience in reference data management, trend analysis, and team leadership within the healthcare or insurance domain.

Key Responsibilities:

• Lead and perform accurate coding and classification of diagnoses, procedures, and services using ICD-10-CM, ICD-10-PCS, CPT, and HCPCS standards.
• Support Rules & Benefits Development for claims processing, billing schedules, and FWA (Fraud, Waste, and Abuse) detection initiatives.
• Manage Reference Data including value sets, concepts, and reference lists to ensure consistency and compliance with industry standards.
• Conduct data validation, audits, and peer reviews to maintain accuracy and high-quality coding outputs.
• Perform research and trend analysis on APAC and global FWA guidelines, regulatory changes, and evolving coding standards.
• Provide leadership and mentorship to coding teams, offering training, feedback, and performance guidance.
• Serve as the client point of contact, facilitating clear communication, reporting, and issue resolution.
• Collaborate with internal stakeholders such as quality assurance, analytics, and compliance teams for continuous process improvement.
• Ensure adherence to organizational and regulatory requirements, maintaining confidentiality and data protection.

Job Type: Full-time

Work Location: In person