Healthcare Coding Expert (certified professional coder)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Healthcare Coding Expert (Certified Professional Coder) based in India. This role offers an opportunity to apply deep healthcare coding and claims expertise to initiatives focused on identifying and preventing fraud, waste, and abuse. You will analyze complex medical claims data, identify potential risks and patterns, and develop actionable leads and referrals. Working as part of a multidisciplinary healthcare analytics team, you will contribute to projects supporting program integrity and better use of healthcare resources. The position combines detailed claims analysis with policy research, investigative work, reporting, and quality assurance. You will collaborate with internal and external stakeholders and help translate analytical findings into meaningful outcomes. Your expertise in coding standards, reimbursement methodologies, and healthcare compliance will be central to maintaining accuracy and regulatory alignment. The role also provides opportunities to guide less experienced professionals and contribute to complex projects with significant public-sector impact. Perform analytical activities supporting healthcare fraud, waste, and abuse prevention initiatives, including identifying potential referrals and investigative leads. Analyze medical claims data to identify trends, anomalies, patterns, and potential indicators of fraud, waste, or abuse. Review medical claims for accuracy, completeness, coding compliance, reimbursement appropriateness, and adherence to applicable insurance policies. Apply expertise in ICD-10, CPT, HCPCS, medical terminology, reimbursement methodologies, and healthcare coding guidelines to claims analysis. Research healthcare policies, coding standards, reimbursement criteria, and regulatory requirements to support investigations and referrals. Contribute to the development of analytical reports and communicate findings and outcomes to relevant stakeholders. Track and support outcome metrics associated with fraud, waste, and abuse referrals and leads shared with participating partners. Analyze healthcare claims data to support study referrals, investigative leads, provider background profiles, and potential collaboration opportunities. Respond to questions regarding analytical outputs from internal and external stakeholders, providing clear explanations and evidence-based conclusions. Participate in quality assurance activities to ensure deliverables meet regulatory requirements, healthcare policies, industry standards, and project expectations. Support program integrity activities, including audits, pre-payment and post-payment reviews, investigations, edits, and referrals. Maintain strict confidentiality and protect sensitive healthcare information in accordance with applicable privacy and security requirements. Provide coaching, guidance, and knowledge-sharing to less experienced professionals when needed. Manage complex analytical assignments independently while maintaining accuracy, deadlines, and organizational priorities. Requirements Bachelor’s degree or equivalent combination of education and relevant professional experience. 8+ years of experience in healthcare claims analysis or a closely related healthcare analytics discipline. Active Certified Professional Coder (CPC) certification through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) certification through the American Health Information Management Association (AHIMA). Extensive knowledge of medical terminology and healthcare coding systems, including ICD-10, CPT, and HCPCS. Demonstrated experience in healthcare program integrity and fraud, waste, and abuse activities, including audits, investigations, edits, pre-payment and post-payment reviews, and referrals. Strong understanding of insurance regulations, reimbursement methodologies, healthcare policies, and com