Medical Coder

Cotiviti; Pune District; On-site; INR 600,000 - 900,000; Full time

Job summary

Cotiviti in Pune, India is seeking a Coding Auditor to review medical records and claims for coding accuracy and potential fraud, waste and abuse. You will prepare medical review summaries with clear rationale for claim determinations and support investigations with thorough coding research.

Ideal candidates have 2–5 years of medical coding/auditing experience, CPC certification, knowledge of ICD/CPT/HCPCS; willingness to work night shifts and across shifts, with strong analytical and

Qualifications

• 2–5 years of relevant medical coding/auditing experience.
• CPC certification is mandatory.
• Knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, CMS/NCCI guidelines.
• Healthcare claims/FWA experience is preferred.
• Strong analytical, research, communication and attention-to-detail skills.
• Good knowledge of MS Office.
• Candidates should be willing to work in different shifts, including night shifts.

Responsibilities

• Review medical records and claims for coding accuracy and potential fraud/waste/abuse.
• Prepare medical review summaries with clear rationale for claim determinations.
• Conduct research related to investigations and medical coding.
• Identify suspicious patterns using coding guidelines, reimbursement methodologies, and healthcare regulations.
• Ensure compliance with federal/state policies and CMS/NCCI guidelines.
• Support special projects and maintain updated knowledge of coding standards.

Skills

Analytical skills

Research skills

Attention to detail

Communication skills

MS Office

Education

CPC certification

Job description

Job Title: Coding Auditor

Job Summary: We are looking for a Coding Auditor to review medical records and claims in support of Fraud, Waste & Abuse (FWA) investigations and program integrity initiatives.

Key Responsibilities:

• Review medical records and claims for coding accuracy and potential fraud/waste/abuse.
• Prepare medical review summaries with clear rationale for claim determinations.
• Conduct research related to investigations and medical coding.
• Identify suspicious patterns using coding guidelines, reimbursement methodologies, and healthcare regulations.
Id? ensure compliance with federal/state policies and CMS/NCCI guidelines.
• Support special projects and maintain updated knowledge of coding standards.

Requirements:

• 2-5 years of relevant medical coding/auditing experience.
• CPC certification is mandatory.
• Knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDC and CMS/NCCI guidelines.
• Healthcare claims/FWA experience is preferred.
• Strong analytical, research, communication and attention-to-detail skills.
• Good knowledge of MS Office.
• Candidates should be willing to work in different shifts, including night shifts.