Medical Coding Auditor (Payment Integrity)

Keka Inc.; Bengaluru; On-site; INR 600,000 - 900,000; Full time

Benefits offered by this job

Best-in-class compensation

Health insurance for Family

Flexible leave policy

Certification reimbursement

CEUs and renewals

Job summary

CoverSelf in Bengaluru is seeking a Medical Coding Auditor (Payment Integrity) to perform hands-on claims review, coding validation, and RCM support. You will identify coding and billing errors and help improve payment accuracy while ensuring adherence to CMS guidelines.

Responsibilities include analyzing claims with RCM workflows, working on UB-04 and CMS 1500 forms, and collaborating with internal teams to drive claim accuracy in a fast-paced environment.

Qualifications

• Education or certification in medical coding and RCM is required or preferred.
• Must have knowledge of CPT, ICD, HCPCS, NCCI edits, modifiers and Medicare physician fee schedule.
• Experience with CMS, Medicaid provider manuals and CMS publications is a plus.

Responsibilities

• Perform manual claims review and identify coding/billing errors
• Analyze claims using RCM workflows and 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

Skills

Medical Coding

Claims Audit

RCM

NCCI Edits

Modifiers

Attention to detail

Analytical skills

Problem solving

US Healthcare

CPT/ICD/HCPCS

Nurse claims review

Education

Medical Degree (MBBS etc)

Nursing: BSc/MSc in Nursing

Pharmacist Degree (B.Pharm/M.Pharm/PharmD)

Life Science - Bachelors/Masters

Job description

Medical Coding Auditor (Payment Integrity)

1-3

Full-Time

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

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
• 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.

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.
• High proficiency in Microsoft Word and Excel, with adaptability to new platforms.
• Excellent Interpretation and articulation skills
• Strong analytical, critical thinking, and problem-solving skills
• Willingness to learn new products and tools
• Mode: Work from Office
• Best-in-class compensation
• Health insurance for Family
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• 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.