Job Description
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Key Responsibilities
- Perform quality audits on post pay E/M coding assignments to ensure accuracy, completeness, and compliance with CMS and payer-specific regulations.
- Review coded medical records for adherence to ICD-10-CM, CPT®, and HCPCS Level II guidelines.
- Validate coding against 1995/1997 and 2021 AMA/CMS E/M documentation guidelines.
- Identify coding errors, trends, and training needs, and provide actionable feedback to coders.
- Collaborate with Team Leads, trainers, and compliance teams to improve coding performance.
- Support audit responses, compliance reviews, and risk adjustment initiatives.
- Track and report error rates, productivity metrics, and quality trends.
- Maintain updated knowledge of coding guidelines, payer policies, and industry best practices.
- Ensure strict adherence to HIPAA and data confidentiality standards.
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- Bachelor’s degree in Life Sciences, Nursing, paramedic or a related healthcare field
- Minimum 3–5 years of medical coding experience with strong knowledge of Evaluation & Management services.
- Certified Professional Coder (CPC) or Certified Evaluation & Management Coder (CEMC) or Certified Coding Specialist (CCS) or equivalent credential required.
- Demonstrated experience in coding audits, quality review, or compliance checks.
- Strong understanding of ICD-10-CM, CPT®, HCPCS Level II coding, and E/M documentation guidelines.
- Familiarity with CMS, payer-specific rules, and 2021 E/M updates.
- Proficiency in EMR/EHR and coding software systems.
- Excellent analytical, communication, and documentation skills.
- Prior experience as a coding auditor, quality reviewer, or compliance analyst in E/M coding and exposure to post pay payer audit processes will be an advantage.
- Ability to design and deliver coder feedback or micro-trainings based on audit findings will be preferred.
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Mandatory Skills: Claims_Processing .
Experience: 3-5 Years .
The expected compensation for this role ranges from $75,000 to $85,000 .
Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro's standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law.
Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome.
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