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 / RadiologyDMEAny Medical Coding SpecialtyKey Responsibilities:Perform manual claims review and identify coding/billing errorsValidate CPT, ICD, HCPCS codes, modifiersSupport denials management & pre/post payment reviewAnalyze claims using RCM workflows & reimbursement methodologiesFlag incorrect claims and recommend correctionsEnsure compliance with CMS, NCCI, Medicare/Medicaid guidelinesWork on UB-04 / CMS 1500 claims formsCollaborate with internal teams to improve claim accuracyRequirements:Strong expertise in Medical Coding & RCM processesHands-on experience in claims audit and validationUnderstanding of coding guidelines, billing workflows, and complianceStrong domain expertise Semi automated Claims reviewSolid 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 1500Collaborate effectively across teams while managing multiple prioritiesAbility 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 deliverablesQualificationsEducation & Certification (one of the following required):Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)Nursing: Bachelor/Master of Science in NursingPharmacist Degree (B.Pharm, M.Pharm or PharmD)Life Science -Bachelor/MasterCertification 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 Review3+ years experience for Analyst5+ years experience for TL10+ Years for Manager13+ years for Senior ManagerExperience in rule requirement Semi automated Claims Review.Experience in claims review, denials, coding validationKey Skills:Medical Coding (CPT, ICD, HCPCS)Claims Audit & ValidationRCM & Denials ManagementKnowledge of NCCI edits, modifiersNurse claims ReviewAttention to detail & analytical skillsDomain 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 etcHigh proficiency in Microsoft Word and Excel, with adaptability to new platforms.Excellent verbal & written communication skills.Excellent Interpretation and articulation skillsStrong analytical, critical thinking, and problem-solving skillsWillingness to learn new products and toolsWork Details:Location: Jayanagar, BangaloreMode: Work from OfficeBenefits:Best-in-class compensationHealth insurance for FamilyPersonal Accident InsuranceFriendly and Flexible Leave PolicyCertification and Course ReimbursementMedical Coding CEUs and Membership RenewalsHealth checkupAnd many more!
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!
