About the role
Position Overview:This role focuses on hands-on claims review, coding validation, and RCM processes. The Coding Auditor will identify incorrect coding/billing, support denials management, and ensure compliance with payer and CMS guidelines to improve payment accuracy.
Specialty Expertise:Evaluation & Management (E/M)Surgery / Anesthesia / RadiologyDMEAny Medical Coding Specialty
Key Responsibilities:Perform manual claims review and identify coding/billing errorsValidate CPT, ICD, HCPCS codes, modifiersSupport denials management & pre/post payment reviewAnalyze claims using RCM workflows & reimbursement methodologiesFlag incorrect claims and recommend correctionsEnsure compliance with CMS, NCCI, Medicare/Medicaid guidelinesWork on UB-04 / CMS 1500 claims formsCollaborate with internal teams to improve claim accuracyRequirements:
- Strong expertise in Medical Coding & RCM processes
- Hands-on experience in claims audit and validation
- Understanding of coding guidelines, billing workflows, and compliance
- Strong domain expertise Semi automated Claims review
- Solid understanding of medical coding & billing methodologies and guidelines, including CPT, ICD, LCD/NCD, PTP, NCCI, edits, modifiers, Medicare Physician fee schedule, and coding conventions.
- Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals and other Medical publications.
- Translate industry references into actionable business logic to support new rules and policy enhancements.
- Strong understanding of claim forms like UB-04/CMS 1450 and CMS 1500
- Collaborate effectively across teams while managing multiple priorities
- Ability to thrive in a fast-paced, dynamic environment with minimal supervision.
- Demonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement and maintenance.
- Strong stakeholder management, interpersonal, and leadership skills.
- Solution-focused, motivated, entrepreneurial spirit with a strong sense of ownership.
- Clear and effective communication.
- Strong attention to accuracy and detail in all deliverables
- Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
- Nursing: Bachelor/Master of Science in Nursing
- Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
- Life Science -Bachelor/Master
- Must be CPC Certified
- Additional weightage will be given for AAPC specialty coding certifications.
- Lean Six Sigma certification and practical application experience are preferred.
Experience:
- 1-3 Experience in Payment Integrity Content/Research, Semi automated Claims Review
- Experience in rule requirement Semi automated Claims Review.
- Experience in claims review, denials, coding validation
- Medical Coding (CPT, ICD, HCPCS)
- Claims Audit & Validation
- RCM & Denials Management
- Knowledge of NCCI edits, modifiers
- Nurse claims Review
- Attention to detail & analytical skills
- Domain Expertise in US Healthcare Medical Coding, Medical Billing, Payment Integrity, Revenue Cycle Management (RCM), Denials Management.
- Codeset Knowledge like CPT/HCPCS, ICD, Modifier, DRG, PCS, etc.
- Payment Policies knowledge like Medicare/Medicaid Reimbursement, Payer Payment Policies, NCCI, IOMs, CMS Policies etc
- High proficiency in Microsoft Word and Excel, with adaptability to new platforms.
- Excellent verbal & written communication skills.
- Excellent Interpretation and articulation skills
- Strong analytical, critical thinking, and problem-solving skills
- Willingness to learn new products and tools
Work Details:
- Location: Jayanagar, Bangalore
- Mode: Work from Office
- Best-in-class compensation
- Health insurance for Family
- Personal Accident Insurance
- Friendly and Flexible Leave Policy
- Certification and Course Reimbursement
- Medical Coding CEUs and Membership Renewals
- Health checkup
- And many more!