Hiring Multi Specialty Medical Coders For Pune Location

Optum; Pune District; On-site; INR 450,000 - 900,000; Full time

Job summary

Optum in Pune is hiring for multi-specialty coders. The role involves verifying diagnosis and procedure codes, auditing records for CMS compliance, and ensuring documentation supports billing.

You will work with ICD-10, CPT, HCPCS, and denial coding, coordinating with billing teams, and navigating systems like COSMOS/Facets, ATS, and CMS resources. Strong communication and attention to detail are essential.

Qualifications

• Bachelor's Degree or 5+ years of technical writing experience.
• 4+ years Coding and auditing experience E&M, CPT, HCPCS, Preferable Denial Coding.
• Exposure in client interactions, Multispecialty coding experience in Denial Coding E/M, ED, Surgery/OP/IP either two out of 6.
• Experience with spreadsheet and word processing management, such as Excel and Word.
• Demonstrated ability to manage and prioritize deliverables.
• Excellent verbal and written communication skills.
• Proven organizational skills with ability to be flexible and work with ambiguity.
• Work with minimal guidance; seek guidance on only the most complex tasks.
• Requires attention to detail.

Responsibilities

• Validate the claim denial reason and logic in internal claim processing platforms according to CMS coding policies.
• From a Part C perspective, cannot use UHC payment policies unless CMS source supports.
• Search for information in cases where coding is complex or unusual.
• Interpret appeal, validate claim processing, and tie denial to applicable CMS policy and date of service.
• Ensure all provider arguments are reviewed with a concise timeline narrative and direct sourcing.

Skills

Coding & auditing

Attention to detail

Communication skills

Prioritization

Ambiguity handling

Education

Bachelor's Degree or 5+ years of technical writing experience

Tools

COSMOS/Facets

Claim forms

ATS

CMS.gov

Outpatient Code Editor

CES

SAM edit

Job description

Hi All,

Hiring Multi Specialty Coders for Pune Location

Job description

Coder Functions:

• Verifying the coding of the diagnosis, evaluation and management, procedures, modifiers or other codes required for the completeness and accuracy of the record.
• Review, examine and verify component parts of medical records:
• Ensure completeness and accuracy of billed service
• Consistency and completeness of coding using established CMS criteria and regulations
• Authorized signatures and patient identification to ensure all documents contain sufficient documentation to support the diagnosis and treatment administered, and the results obtained are adequately described.
• Review diagnosis, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs with International Classification of Diseases (ICD10), Current Procedural Terminology (CPT), Heath Care Financing Administration Common Procedure Coding Systems (HCPCS all levels, and any other coding classification systems that may be required).

Ability to navigate & understand functionality:

• COSMOS/Facets
• Claim forms
• ATS
• CMS.gov
• Outpatient Code Editor
• CES
• SAM edit

Required Qualifications:

• Bachelor's Degree or 5+ years of technical writing experience
• 4+ years Coding and auditing experience E&M, CPT, HCPCS, Preferable Denial Coding.
• Exposure in client interactions, Multispecialty coding experience in Denial Coding E/M, ED, Surgery/OP/IP either two out of 6.
• Experience with spreadsheet and word processing management, such as Excel and Word.
• Demonstrated ability to manage and prioritize deliverables.
• Excellent verbal and written communication skills.
• Proven organizational skills with ability to be flexible and work with ambiguity.
• Work with minimal guidance; seek guidance on only the most complex tasks.
• Requires attention to detail.

Preferred Qualifications:

• Coding Certification (examples: CPC, CCS / CCS-P, RHIT, RHIA, etc.) or willing to obtain upon hire.
• Experience with standard healthcare industry code sets such as E&M, CPT, HCPCS, ICD10, etc.
• Must possess knowledge on Denials and Medicare & Medicaid policies and CMS Guidelines

Coder Appeal Responsibilities:

• Validate the claim denial reason and logic in our internal claim processing platforms and confirm that the logic is correctly applied according to CMS coding policies, including, but not limited to: NCCI Policy, NCD/LCD, Medicare Claim Processing Manuals
• From a Part C perspective, we cannot use UHC payment policies unless there is a direct CMS source of truth to support
• Search for information in cases where the coding is complex or unusual
• Interpret appeal, validate claim processing, and tie that denial of service directly to a CMS policy that is both applicable to the date of service and provider specialty, to determine if the denial should be overturned or upheld.
• Ensure all the provider's arguments are reviewed and resolved with a concise timeline narrative/explanation including the direct sourcing to support the denial/uphold (if applicable)