Senior Medical Coder- Multi Specialty Coders- Pune

Optum; Pune District; On-site; INR 600,000 - 1,000,000; Full time

Job summary

Optum in Pune, India is seeking a detail-oriented Coder with strong experience in medical coding and auditing. The role focuses on verifying diagnosis, E/M, CPT, HCPCS, and other codes, ensuring completeness and CMS compliance, and supporting denials management.

The ideal candidate has a Bachelor's degree or 5+ years of technical writing plus proven ability to navigate coding systems, CMS guidelines, and denial appeals, with excellent communication and organizational skills.

Qualifications

• Bachelor's degree or 5+ years of coding/auditing experience in E/M, CPT, HCPCS.
• Experience with denial coding and CMS guidelines.
• Strong Excel/Word skills and client interaction experience.

Responsibilities

• Verify coding of diagnosis, E/M, CPT, HCPCS and procedures for completeness and accuracy.
• Review medical records for completeness and CMS compliance and proper documentation.
• Assess provider documentation and ensure adequate justification of diagnoses and treatments.

Skills

Coding & auditing

CMS policies

Attention to detail

Verbal & written comms

Education

Bachelor's Degree

Tools

COSMOS/Facets

Outpatient Code Editor

CMS.gov

Job description

Coder Functions:

• Verifying the coding of the diagnosis, evaluation and management, procedures, modifiers or other codes required for the completeness and accuracy of the record.
• Review, examine and verify component parts of medical records:
  • Ensure completeness and accuracy of billed service
  • Consistency and completeness of coding using established CMS criteria and regulations
  • Authorized signatures and patient identification to ensure all documents contain sufficient documentation to support the diagnosis and treatment administered, and the results obtained are adequately described.
• Review diagnosis, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs with International Classification of Diseases (ICD10), Current Procedural Terminology (CPT), Heath Care Financing Administration Common Procedure Coding Systems (HCPCS all levels, and any other coding classification systems that may be required).

Coder Appeal Responsibilities:

• Validate the claim denial reason and logic in our internal claim processing platforms and confirm that the logic is correctly applied according to CMS coding policies, including, but not limited to: NCCI Policy, NCD/LCD, Medicare Claim Processing Manuals
• From a Part C perspective, we cannot use UHC payment policies unless there is a direct CMS source of truth to support
• Search for information in cases where the coding is complex or unusual
• Interpret appeal, validate claim processing, and tie that denial of service directly to a CMS policy that is both applicable to the date of service and provider specialty, to determine if the denial should be overturned or upheld.
• Ensure all the provider's arguments are reviewed and resolved with a concise timeline narrative/explanation including the direct sourcing to support the denial/uphold (if applicable)

Ability to navigate & understand functionality:

• COSMOS/Facets
• Claim forms
• ATS
• CMS.gov
• Outpatient Code Editor
• CES
• SAM edit

Required Qualifications:

• Bachelor's Degree or 5+ years of technical writing experience
• 5+ years’ Coding and auditing experience E&M, CPT, HCPCS, Preferable Denial Coding.
• Exposure in client interactions, Multispecialty coding experience in Denial Coding E/M, ED, Surgery/OP/IP either two out of 6.
• Experience with spreadsheet and word processing management, such as Excel and Word.
• Demonstrated ability to manage and prioritize deliverables.
• Excellent verbal and written communication skills.
• Proven organizational skills with ability to be flexible and work with ambiguity.
• Work with minimal guidance; seek guidance on only the most complex tasks.
• Requires attention to detail.

Preferred Qualifications:

• Coding Certification (examples: CPC, CCS / CCS-P, RHIT, RHIA, etc.) or willing to obtain upon hire.
• Experience with standard healthcare industry code sets such as E&M, CPT, HCPCS, ICD10, etc.
• Must possess knowledge on Denials and Medicare & Medicaid policies and CMS Guidelines