Medical Coding Auditor (Payment Integrity)

Job description

# Medical Coding Auditor (Payment Integrity) > 2070Health · Bengaluru, India · Full-time · Posted 2026-06-05 **Workplace:** on_site **Department:** 2070 Health ## 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! ## Apply [Apply at 2070Health](https://apply.workable.com/2070health/j/4153DF276F/apply) --- Powered by [Workable](https://www.workable.com)