Coder Executive

Sagility India; Hyderabad; On-site; INR 1,500,000 - 2,200,000; Full time

Job summary

Sagility India is seeking an experienced Denial Coder with 12 years of expertise to review denied healthcare claims and support appeals. The role requires validating coding accuracy, identifying denial root causes, and ensuring alignment with payer guidelines and coding regulations.

The candidate will collaborate with billing and denial teams to resolve claims efficiently, maintain records of denial trends, and meet defined productivity and quality targets. US shift timings apply.

Qualifications

• 12 years of denial coding or denial management experience.
• Active CPC certification from AAPC is mandatory.
• Strong knowledge of ICD-10-CM, CPT and HCPCS coding systems.
• Understanding US healthcare billing, claims processing and payer denial codes.
• Experience reviewing medical records for coding discrepancies.

Responsibilities

• Review denied medical claims and identify root causes.
• Analyze records to validate coding accuracy and rationale.
• Identify denials related to ICD-10-CM, CPT, HCPCS codes.
• Review denial codes and EOBs for resolution opportunities.
• Investigate denials related to medical necessity, authorization and eligibility.
• Correct coding errors and advise on claim adjustments or resubmissions.
• Support appeals with clinical and coding documentation.
• Ensure compliance with coding guidelines and payer policies.
• Coordinate with billing and denial teams to resolve claims.
• Maintain records of denial trends and resolutions.
• Meet productivity, quality and turnaround targets.

Skills

Denial coding

ICD-10-CM CPT HCPCS

Analytical skills

Communication

Education

Any Graduate

Tools

Medical billing systems

Electronic Health Records

Job description

Job Title: Executive Coder

Experience: 12 Years

Qualification: Any Graduate

Certification: Active CPC (Certified Professional Coder) Certification is mandatory

Job Summary

We are looking for a detail-oriented Denial Coding with 12 years of experience in medical coding and denial management. The candidate will be responsible for reviewing denied healthcare claims, identifying denial reasons, validating medical coding accuracy, and supporting the appeals and claims resolution process in accordance with payer guidelines and coding regulations.

Key Responsibilities

• Review denied medical claims and identify the root cause of denials.
• Analyze medical records, clinical documentation, and coding details to validate claim accuracy.
• Identify coding-related denials, including incorrect ICD-10-CM, CPT, and HCPCS codes, as applicable.
• Review denial codes, remittance advice, and Explanation of Benefits (EOB) documents.
• Investigate claim denials related to medical necessity, authorization, eligibility, and coding discrepancies.
• Correct coding errors and recommend appropriate claim adjustments or resubmissions.
• Support the preparation of appeals and reconsideration requests with relevant clinical and coding documentation.
• Ensure compliance with official coding guidelines, payer policies, and healthcare regulations.
• Coordinate with billing, coding, and denial management teams to resolve outstanding claims.
• Maintain accurate records of denial trends, root-cause analysis, and resolution outcomes.
• Meet established productivity, quality, and turnaround-time (TAT) targets.

Required Qualifications

• 12 years of relevant experience in denial coding or denial management.
• Active CPC (Certified Professional Coder) certification from AAPC.
• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
• Understanding of US healthcare billing, claims processing, and payer denial codes.
• Experience reviewing medical records and identifying coding discrepancies.
• Knowledge of claim appeals, resubmissions, and denial resolution workflows.
• Strong analytical skills, attention to detail, and communication abilities.

Preferred Skills

• Experience working with US healthcare clients.
• Familiarity with EOBs, ERAs, and remittance advice.
• Knowledge of medical terminology, anatomy, and disease processes.
• Ability to analyze denial trends and recommend corrective actions.
• Proficiency in medical billing systems and electronic health records.

Key Performance Indicators (KPIs)

• Coding accuracy and quality scores.
• Denial resolution rate.
• Productivity and turnaround time.
• Reduction in recurring coding-related denials.
• Compliance with payer guidelines and organizational standards.

Employment Type: Full-time
Work Location: As per company requirements
Experience Level: 1–2 Years

Shifts : US Shifts