Medical Coders - QA/SME Specialist

City: Tampa

State/Province: Florida

Posting Start Date: 1/22/26

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.

Job Description:

Job Description

Position Summary

Quality Analyst/ SME for GMC & E&M services for medical coding who will be responsible for conducting quality reviews, ensuring compliance with CMS and payer-specific guidelines, and driving accuracy within health Insurance coding operations. The Quality Analyst will serve as a key resource for coding audits, error analysis, coder feedback and supporting revenue integrity initiatives. This leadership position will assist in supervising and leading a team of medical coders specializing in GMC & E&M services.

Job Description

• Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration.
• Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted.
• Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations.
• Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
• Conducts research of claims systems (i.e Facets, Encoder Pro, etc) and system edits to identify adjudication issues and to audit claims adjudication for accuracy
• Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.
• Create and maintain Quality assurance program.
• Mandatory experience in payor insurance processes (Must)
• Supervise and lead a team of medical coders specializing in GMC & E&M services. Minimum 15 team members.
• Assign, monitor, and review coding work to ensure accuracy, timeliness, and compliance with CMS and payer-specific requirements.
• Conduct regular quality audits and provide feedback to coders to maintain error rates within acceptable thresholds.
• Serve as the SME for GMC & E&M coding guidelines, 1995/1997 and 2021 AMA/CMS updates, and documentation requirements.
• Collaborate with providers, auditors, and compliance teams to address queries and resolve coding discrepancies.
• Develop and deliver training programs for new and existing coders on GMC & E&M coding and documentation changes.
• Track team productivity, create performance reports, manage coding performance and perform in depth analysis on performance as needed.
• Support medical necessity and revenue integrity initiatives through accurate GMC & E&M code assignment.

QUALIFICATIONS:

• Live within the Tampa Bay or Atlanta Metro area. May be required to come into the local office on occassion.
• REQUIRED Certified & active serving Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required
• Experience with appeals and denials (NCD/LCD, Duplicate, MUE)
• REQUIRED - minimum of 5 years of prior E&M/GMC experience
• Minimum of 5 years of experience in a leadership capacity
• Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.
• REQUIRED - Minimum 3 years experience reviewing denied claims and performing coding audits in a healthcare or insurance environment
• Experience handling multiple internal and external stakeholders.
• Excellent analytical, communication, and documentation skills with an emphasis on attention to detail.
• Ability to interpret medical records and apply coding principles accurately.
• Prior experience leading a coding team or acting as a Quality Reviewer/SME in GMC & E&M coding.
• Ability to work independently and as part of a team in a fast-paced environment.

Mandatory Skills: Claims_Processing .

Experience: 3-5 Years .

The expected compensation for this role ranges from $80,000 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.

Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention.

Client-provided location(s): Tampa, FL

Job ID: Wipro-124098

Employment Type: OTHER

Posted: 2026-01-22T18:45:47