About the role
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!
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