Medical Coding Auditor (Payment Integrity)

Xponentiate

Bengaluru

On-site

INR 1,400,000 - 2,100,000

Full time

14 days+

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Benefits offered by this job

Health insurance

Certification and Course Reimbursement

Medical Coding CEUs

Health checkups

Job summary

CoverSelf, a cloud-native healthcare platform, is seeking a Coding Auditor in Bengaluru to perform manual claims review and ensure coding accuracy. You will validate CPT/ICD/HCPCS Codes and support denials management while aligning with CMS guidelines. This role requires strong domain knowledge and attention to detail.

Join a fast-paced team focused on improving payment integrity and reimbursement accuracy for US healthcare payers.

Qualifications

Hands-on claims review and coding validation.
Knowledge of CMS, NCCI, and payer guidelines.
Experience with UB-04 and CMS 1500 forms.

Responsibilities

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

Skills

Medical Coding

RCM & Denials Management

Claims Audit & Validation

CPT/ICD/Billing guidelines

Attention to detail

Analytical thinking

Stakeholder management

Communication skills

Education

MBBS / BDS / BPT / BAMS

B.Sc. Nursing / M.Sc. Nursing

B.Pharm / M.Pharm / PharmD

Life Science degree

Tools

MS Word

MS Excel

Job description

This role is not for 2070 Health.

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 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.
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