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Open nowPosted 121 days ago

Medical Coding Auditor (Payment Integrity)

Workable (global search)108,016 open roles

Where
Bengaluru, KA, India
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Your applicationOpen nowMedical Coding Auditor (Payment Integrity)Workable (global search) · Bengaluru, KA, India

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The clock on this job

Early applications get read.

7.9% of postings close within 7 days. Measured by our own scanner across the market. Workable (global search) postings stay open a median of 7 days.

Share of postings closed within
  1. 1.6%1 day
  2. 3.6%3 days
  3. 7.9%7 days
  4. 14.9%14 days
  5. 34.0%30 days
This job: posted 121 days ago

Workable (global search) median: 7 days open

The posting

This role is not for 2070 Health.

About CoverSelf:

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

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 / Radiology

DME

Any Medical Coding Specialty

Key Responsibilities:

Perform manual claims review and identify coding/billing errors

Validate CPT, ICD, HCPCS codes, modifiers

Support denials management & pre/post payment review

Analyze claims using RCM workflows & reimbursement methodologies

Flag incorrect claims and recommend corrections

Ensure compliance with CMS, NCCI, Medicare/Medicaid guidelines

Work on UB-04 / CMS 1500 claims forms

Collaborate with internal teams to improve claim accuracy

Requirements:

  • 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

Qualifications

Education & Certification (one of the following required):

  • 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

Certification Requirements:

  • Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.
  • Additional weightage will be given for AAPC specialty coding certifications.
  • Lean Six Sigma certification and practical application experience are preferred.

Experience:

  • Experience in Payment Integrity Content/Research, Semi automated Claims Review
  • 3+ years experience for Analyst
  • 5+ years experience for TL
  • 10+ Years for Manager
  • 13+ years for Senior Manager
  • Experience in rule requirement Semi automated Claims Review.
  • Experience in claims review, denials, coding validation

Key Skills:

  • 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

Benefits:

  • 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!
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