The Case for Global Coding — Key Insights for Health System Leaders

As healthcare organizations face persistent financial pressures, increasing coding complexity, and workforce shortages, many are reevaluating how they staff and structure their coding operations. One strategy that consistently surfaces in operational reviews and leadership discussions is the use of global coding operations, a hybrid workforce model that blends local expertise with offshore labor to increase scalability, reduce costs, and stabilize throughput. 

While global staffing offers meaningful advantages, it is not without challenges. Achieving sustained benefit requires deliberate planning, disciplined governance, and thoughtful workforce alignment.

Below is a high level view of why organizations pursue global models, what benefits are achievable, and where the most significant risks and operational pitfalls tend to occur.

Why Organizations Pursue Global Coding Strategies

1. The Need for Predictable and Scalable Capacity

Coding volumes vary widely due to seasonal trends, service mix changes, and regulatory shifts. Traditional staffing models often struggle with hiring, retention, and training delays. Global partners offer large, scalable teams that can absorb fluctuating volumes quickly with extended operating hours.

2. Pressure to Reduce Labor Costs

Labor accounts for most of the expense within coding operations. Offshoring well defined and lower complexity work can generate meaningful savings, especially when internal staff are refocused on higher complexity cases. Cost reductions increase when pricing is based on FTE models that create predictable budgeting.

3. Desire to Improve Turnaround Time and Revenue Flow

Slow coding creates downstream delays in billing and cash flow. A global model supports continuous processing, shorter backlogs, and more reliable turnaround times without expanding expensive domestic staffing.

4. Increased Opportunity to Pair Staffing with Automation 

Automation and AI tools are reducing the volume of repetitive work. A global staffing model allows internal coders to focus on complex or exception based cases while offshore teams manage standardized, repeatable work that aligns well with automated workflows.

Benefits Organizations Can Achieve

1. Lower Total Coding Cost

Shifting work offshore can reduce total labor expense even when reinvesting in internal quality, reporting, and vendor management. These savings expand when paired with work queue consolidation, edit reduction, productivity improvements, and technology enhancements.

2. Workforce Stabilization

A global strategy helps reduce pressure on internal staff, slow attrition, and manage the effects of ongoing workforce shortages.

3. Higher Productivity and Throughput

Global teams often operate with structured productivity expectations and defined workflows. When combined with internal process redesign, organizations frequently see increased throughput and fewer operational bottlenecks.

4. Stronger Quality Oversight 

Successful global programs invest in internal quality management. This builds a more consistent oversight structure across both domestic and offshore work and helps maintain accuracy at scale.

Pitfalls and Risks to Consider Before Pursuing a Global Model

1. Increased Attrition When Productivity Standards Change

Raising productivity expectations can create stress and contribute to turnover. This risk is highest during the initial transition and must be managed through coaching, communication, and structured performance support.

2. Quality Risks During Vendor Ramp Up

Offshore teams require deep familiarity with local workflows, provider documentation patterns, payer rules, routing logic, and account note expectations. Without intensive onboarding and daily quality checks, accuracy may dip before stabilizing.

3. Overly Complex or Fragmented Workflows

If work queues, routing logic, or edits are highly fragmented, offshore teams often struggle to maintain consistency. Work must be consolidated, standardized, and clearly defined before transitioning volume offshore.

4. Underestimating Internal Oversight Requirements

Global staffing reduces coding workload but increases oversight. Internal teams must support ongoing quality audits, trend reviews, reporting, SLA tracking, escalation management, and vendor communication. Under resourcing this function often leads to underperformance.

5. Vendor Dependency 

Relying on a single vendor increases operational and security risk. Many organizations use a dual vendor structure to maintain resiliency, competitive performance, and continuity during unexpected disruptions.

6. Misalignment Between Work Complexity and Vendor Readiness

Not all work is suitable for offshore routing. Early phases should focus on predictable, lower complexity work. Sending high complexity or highly nuanced cases offshore too quickly can lead to denials, errors, and rework.

7. Regulatory and State Specific Restrictions

Organizations must understand their state regulatory environment before shifting work offshore. Certain states impose limitations on international processing, confidentiality rules, data handling restrictions, or specific requirements for licensed professionals. Legal and compliance teams should be engaged early to confirm that offshore staffing is permissible and that the appropriate security and privacy safeguards are in place.

8. HR and Workforce Alignment Challenges 

Global strategies often require changes to job descriptions, expanded cross training, new role delineations, and more structured performance management. HR involvement is essential from the outset.

Keys to a Successful Global Strategy 

Organizations that succeed with global staffing typically:

• Build strong internal quality review structures

• Consolidate and simplify work queues before transitioning work

• Standardize documentation, training materials, and workflow expectations

• Segment work by complexity and transition in phased stages

• Use a dual vendor structure for resiliency and competitive performance

• Pair automation with global staffing to increase long term scalability

Conclusion

A global coding strategy can significantly improve cost structure, scalability, quality, and operational performance. However, the benefits are realized only when organizations treat the model as a comprehensive redesign of coding operations rather than a simple outsourcing decision. Clear sequencing, workforce alignment, regulatory review, and disciplined quality oversight are essential. When implemented thoughtfully, global staffing strengthens the coding function and positions the organization for long term success.