Medical Coding Audit Manager

Veradigm®

. Manage day-to-day operations of the Medical Coding Evaluation team supporting Veradigm's enterprise coding capability .

Posted 10/2/2026full-timePune • IndiaMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expert-level knowledge of medical coding, including ICD-10-CM, CPT, and HCPCS, while effectively managing a distributed team of certified coders. Proficient in developing coding guidelines and ensuring compliance with HIPAA privacy and security requirements.

Highest-signal resume keywords

Expert-Level Knowledge Of Medical CodingICD-10-CM, CPT, HCPCS CodingActive CPC, CCS, Or CCS-P CertificationCoding Auditing Or Quality Review ExperienceLeadership Experience In Distributed Teams

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10-CM CodingCPT CodingHCPCS CodingCoding AuditingCoding Quality ReviewDeveloping Coding GuidelinesAutomated Coding Tools ReviewInter-Rater AgreementE/M Documentation GuidelinesCMS Claims Processing Rules

Soft Skills

Attention To DetailSound JudgmentClear CommunicationIndependent WorkTeam Leadership

Tools & Technologies

Automated Coding ToolsCompliant Review Tools

Certifications & Qualifications

CPC CertificationCCS CertificationCCS-P CertificationCPMA CertificationCRC Certification

Industry Keywords

Health Information ManagementHealthcare AdministrationMedicare Risk AdjustmentHCC CodingClinical DocumentationMulti-Specialty CodingAmbulatory CodingHIPAA ComplianceClinical Metrics ReportingDistributed Team Management

About the role

Key responsibilities & impact

Manage day-to-day operations of the Medical Coding Evaluation team supporting Veradigm's enterprise coding capability
Review AI agent outputs against clinical documentation to confirm codes are supported, billable, and accurate
Develop and maintain the scoring guide with clinical experts
Manage reviewer assignments, priorities, capacity, and throughput
Adjudicate dual-review disputes and document rationale
Track inter-reviewer agreement and refine review guidance
Run calibration rounds and validate scaling readiness
Report clinical metrics, accuracy, claims inclusion, and risk impact to leadership, product teams, and clients
Plan specialty coverage beginning with internal medicine
Expand evaluation scope into chart preparation and clinical note quality
Validate automated scoring through sampling and report divergences from expert review
Coordinate design-partner evaluations
Enforce approved data access boundaries, authorized data tiers, and compliant review tools
Build and develop a distributed team of certified coders

Requirements

What you’ll need

Bachelor's Degree in Health Information Management, Healthcare Administration, or equivalent technical or business experience
8+ years relevant work experience; 2-3 years at the Expert level or equivalent experience (Preferred)
4 years ICD-10-CM, CPT, and HCPCS coding across multiple specialties, with strong attention to detail and a high accuracy rate
2 years coding auditing or coding quality review
2 years outpatient or ambulatory coding in a multi-specialty or large group practice setting
1 year developing coding guidelines, audit criteria, or annotation standards that others apply
1 year reviewing output from automated or computer-assisted coding tools, or other structured annotation work
Medicare Risk Adjustment or HCC coding experience (preferred)
2-4 years relevant leadership experience, including leading distributed or remote teams (preferred)
Active CPC, CCS, or CCS-P AAPC or AHIMA coding certification (Required)
CPMA certification (Preferred)
CRC certification (Preferred)
Expert-level knowledge of medical coding, including ICD-10-CM, CPT, HCPCS Level II, modifier application, E/M documentation guidelines, and CMS claims processing rules
Ability to write clear, unambiguous evaluation criteria that multiple reviewers can apply consistently
Working understanding of inter-rater agreement, sampling, and reviewer error versus ambiguous guidance
Ability to explain coding reasoning to engineers and product managers and translate technical questions into coding terms
Sound judgment with incomplete documentation or unclear coding guidance
Proven ability to lead distributed teams across locations or time zones
Ability to work independently with minimal supervision
Working knowledge of HIPAA privacy and security requirements for clinical and de-identified data
Requires periodic overlap with United States time zones
Up to 10% travel may be required

Benefits

Comp & perks

Quarterly Company-Wide Recharge Days
Flexible Work Environment (Hybrid)
Peer-based incentive “Cheer” awards
Tuition Reimbursement Program