Medical Coder - Denial Management

Nexcen It Services; Hyderabad; On-site; INR 450,000 - 650,000; Full time

Job summary

Nexcen It Services is seeking a Medical Coder (Denial Management) to review medical records and insurance claims for coding accuracy. You will perform Physician/Pro-fee coding using ICD-10, CPT codes and modifiers, and handle denial management by analyzing EOBs.

The ideal candidate has 4+ years of relevant clinical or hospital experience, mandatory denial management expertise, strong CPT/ICD-10 knowledge, and the ability to read EOBs.

Qualifications

• Experience with CPT, ICD-10 and modifiers.
• Ability to read and interpret EOBs (Explanations of Benefits).
• Strong understanding of medical necessity requirements and insurance claim processing.
• Excellent analytical, communication and documentation skills.

Responsibilities

• Review and analyze medical records, clinical documentation and insurance claims for coding accuracy.
• Perform Physician Coding / Pro-fee Coding using ICD-10, CPT codes and appropriate modifiers.
• Handle Coding Denial Management and identify reasons for claim denials.
• Review and interpret EOBs to understand denial reasons and determine appropriate actions.
• Ensure accurate coding and compliance with medical coding guidelines, insurance regulations and documentation requirements.
• Understand and validate medical necessity requirements for procedures and services.
• Identify coding discrepancies, documentation gaps and errors, and coordinate with relevant teams for clarification.
• Maintain accuracy, quality and productivity while meeting defined SLAs and turnaround times.
• Ensure compliance with healthcare documentation standards and patient data confidentiality.
• Collaborate with operations and quality teams to improve coding accuracy and process efficiency.

Skills

CPT coding

ICD-10 coding

EOB interpretation

Medical necessity

Attention to detail

Education

Bachelor's degree in Science

Job description

Role & responsibilities - Medical Coder (Denial Management)

• Review and analyze medical records, clinical documentation and insurance claims for coding accuracy.
• Perform Physician Coding / Professional Fee (Pro-fee) Coding using ICD-10, CPT codes and appropriate modifiers.
• Handle Coding Denial Management and identify reasons for claim denials.
• Review and interpret EOBs (Explanation of Benefits) to understand denial reasons and determine appropriate actions.
• Ensure accurate coding and compliance with medical coding guidelines, insurance regulations and documentation requirements.
• Understand and validate medical necessity requirements for procedures and services.
• Identify coding discrepancies, documentation gaps and errors, and coordinate with relevant teams for clarification.
• Maintain accuracy, quality and productivity while meeting defined SLAs and turnaround times.
• Ensure compliance with healthcare documentation standards and patient data confidentiality.
• Collaborate with operations and quality teams to improve coding accuracy and process efficiency.

Preferred candidate profile - Medical Coder (Denial Management)

• Minimum 4 years of recent and relevant clinical, hospital or healthcare-related experience.
• Experience in Coding Denial Management is mandatory.
• Hands-on experience in Physician Coding / Professional Fee (Pro-fee) Coding is required.
• Candidates with Facility Coding experience only are not suitable for this position.
• Strong knowledge of CPT, ICD-10 and medical coding modifiers.
• Ability to read, understand and interpret EOBs (Explanation of Benefits).
• Good understanding of medical necessity requirements and insurance claim processing.
• Bachelor's degree in any Science-related field is preferred.
• Knowledge of US Healthcare and Revenue Cycle Management processes.
• Excellent analytical, communication and documentation skills.
• Strong attention to detail with the ability to work independently and meet quality standards.