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!
