Medical Coding Auditor/Denial Coders (Payment Integrity)

Coverself Inc.; Bengaluru; On-site; INR 900,000 - 1,500,000; Full time

Benefits offered by this job

Best-in-class compensation

Family health insurance

Personal accident insurance

Flexible leave policy

Certification and course reimbursement

CEUs and renewals for Medical Coding

Health checkup

Job summary

CoverSelf in Bengaluru is seeking a Coding Auditor to perform manual claims reviews, validate CPT/ICD/HCPCS codes, and support denials management. You will ensure compliance with CMS guidelines, NCCI, and payer policies while collaborating with internal teams to improve claim accuracy.

The role requires hands-on experience in claims review, strong attention to detail, and the ability to translate policy references into practical rules for reimbursement.

Qualifications

• Strong expertise in Medical Coding and RCM processes.
• Hands-on experience in claims audit and validation.
• Deep knowledge of CPT, ICD, HCPCS, NCCI, modifiers and CMS policies.
• Familiarity with UB-04/CMS 1450 and CMS 1500 forms.
• Ability to translate policy references into actionable business logic.

Responsibilities

• Perform manual claims review and identify coding/billing errors.
• Validate CPT, ICD, HCPCS codes and modifiers.
• Support denials management and pre/post payment review.
• Analyze claims using RCM workflows and reimbursement methodologies.
• Collaborate with teams to improve claim accuracy and compliance.

Skills

Medical Coding

RCM & Denials Management

CPT/ICD/HCPCS

NCCI edits & modifiers

Attention to detail

Education

Medical Degree

Nursing Degree

Pharmacist Degree

Life Science Degree

Tools

MS Word

Excel

Job description

About CoverSelf

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

About CoverSelf

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

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 / CMS 1500 claims 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 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/CMS 1450 and CMS 1500
• 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 be CPC Certified
• Additional weightage will be given for AAPC specialty coding certifications.
• Lean Six Sigma certification and practical application experience are preferred.

Experience

• 1-3 Experience in Payment Integrity Content/Research, Semi automated Claims Review
• 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.
• Codeset 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

Work Details

• Location: Jayanagar, Bangalore
• Mode: Work from Office

Benefits

• Best-in-class compensation
• Health insurance for Family
• Personal Accident Insurance
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• Health checkup
• And many more!

Our Commitment To Diversity

At CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose — regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.