Medical Coding Auditor (Payment Integrity)

2070Health; Bengaluru; On-site; INR 800,000 - 1,200,000; Full time

Benefits offered by this job

Best-in-class compensation

Health insurance for Family

Friendly and Flexible Leave Policy

Certification and Course Reimbursement

Job summary

2070Health is looking for a Coding Auditor in Bengaluru, Karnataka. This role involves hands-on claims review, coding validation, and improving payment accuracy.

The ideal candidate will have strong expertise in medical coding, RCM processes, and compliance with payer guidelines. Benefits include best-in-class compensation, health insurance for family, and a flexible leave policy.

Qualifications

• Strong expertise in Medical Coding & RCM processes.
• Hands‑on experience in claims audit and validation.
• Understanding of coding guidelines and compliance.

Responsibilities

• Perform manual claims review and identify coding/billing errors.
• Validate CPT, ICD, HCPCS codes and modifiers.
• Flag incorrect claims and recommend corrections.

Skills

Medical Coding (CPT, ICD, HCPCS)

Claims Audit & Validation

RCM & Denials Management

Attention to detail & analytical skills

Strong communication skills

Education

Medical Degree (e.g., MBBS, BDS, BPT, BAMS)

Nursing: Bachelor/Master of Science in Nursing

Pharmacist Degree (B.Pharm, M.Pharm or PharmD)

Life Science - Bachelor/Master

Tools

Microsoft Word

Microsoft 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 in 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

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!