2070Health
Medical Coding Auditor (Payment Integrity)
Skills
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
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!