Coding Auditor (RCM & Medical Coding)

Angel-and-Genie; Bengaluru; On-site; INR 600,000 - 900,000; Full time

Job summary

Angel-and-Genie in Bengaluru is seeking a Coding Auditor to perform hands-on claims review and coding validation. The successful candidate will ensure compliance with payer and CMS guidelines while supporting denials management to improve payment accuracy.

Ideal applicants should possess strong expertise in Medical Coding and RCM processes, alongside relevant medical qualifications. The position offers engaging responsibilities in a dynamic environment.

Qualifications

• Strong expertise in Medical Coding & RCM processes.
• Hands-on experience in claims audit and validation.
• Understanding of coding guidelines and compliance.

Responsibilities

• Perform manual claims review and identify coding/billing errors.
• Support denials management & pre/post payment review.
• Collaborate with internal teams to improve claim accuracy.

Skills

Medical Coding (CPT, ICD, HCPCS)

Claims Audit & Validation

RCM & Denials Management

Attention to detail & analytical skills

Domain expertise in US Healthcare Medical Coding

High proficiency in Microsoft Word and Excel

Education

Medical Degree (e.g., MBBS, BDS, etc.)

Nursing: Bachelor/Master of Science in Nursing

Pharmacist Degree (B.Pharm, M.Pharm or PharmD)

Life Science – Bachelor/Master

Job description

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/CMS1500 claim 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 in 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/CMS1450 and CMS1500.
• 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.
• Code set 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.