Radiology & Anesthesia - SME

Job Summary:

We are seeking a Senior Medical Coding Subject Matter Expert (SME) with extensive

experience in medical claims for various healthcare settings, including radiology and anesthesia. The ideal candidate will work closely with both clients and internal teams

(technology development, data science) to translate business requirements into technical

deliverables, while also ensuring that claims are accurately and efficiently developed across

various payer types (Medicare, commercial insurers).

The SME will act as a liaison between clients and data science/technology teams to ensure

business requirements are well understood, prioritized, and reflected in the technical

solutions. Strong experience in Excel-based analysis and Python scripting is a plus.

Key Responsibilities:

• Serve as the primary point of contact between clients and internal data science and technical teams, translating medical coding and claims-related business requirements into technical specifications.
• Leverage extensive knowledge of healthcare claims processing for specialties like radiology, surgery, anesthesia, and working with various payers (Medicare and commercial).
• Guide the internal teams on understanding and prioritizing customer requirements to develop impactful, high-quality solutions.
• Review pre-bill claims to ensure accuracy across selected specialties and trainable areas.
• Participate in Ad-hoc coding and audit tasks with an emphasis on delivering accurate coding.
• Conduct data scrubbing, stratification, variance analysis, and opportunity ideation/identification as part of a business analysis (BA) role.
• Collaborate with cross-functional teams to provide updates from data science and technical teams to business stakeholders.
• Perform Excel/ Big data tool-based analysis to identify trends, patterns, and areas of opportunity for process improvement.
• Be flexible in working with different time zones to accommodate client and internal team needs.

Required Skills & Qualifications:

• Minimum of 8 to10 years of medical coding experience with a strong focus on radiology and

anesthesia,

• Comprehensive experience with claims processing across various payer types

(Medicare and commercial).

• Strong performance in trainable, less complex skillsets such as radiology and

anesthesia coding.

• Demonstrated ability to clear pre-bill audits in selected specialties.

• Expertise in Ad-hoc coding and audit work.

• Exposure to business analysis (BA) roles with experience in:

• Data scrubbing
• Data stratification
• Variance analysis
• Opportunity ideation and identification

• Familiarity with Excel/Big data tool-based analysis (required).

• Flexible with working in shifts and participating in cross-time zone calls.

Preferred Qualifications:

• Experience with EPIC platforms or similar EHR systems.

• Experience working in an agile development environment.

• Ability to deliver under tight timelines and adapt to shifting priorities.

Work Locations - Pune or Mumbai - WFO only.

Interested candidates please send your resume to arvind.selvam@exelaonline.com or

Whatsapp your resume to 9791035433