Medical Coding Auditor/Denial Coders (Payment Integrity)
- Location
- Bengaluru, KA, India
- Work mode
- On-site
- Employment type
- Full-time
About the job
Experience: 1-3
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)
- 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
- Must be CPC Certified
- Additional weightage will be given for AAPC specialty coding certifications.
- Lean Six Sigma certification and practical application experience are preferred.
Experience:
• 1-3 Experience in Payment Integrity Content/Research, Semi automated Claims Review
- 1-3 Experience in Payment Integrity Content/Research, Semi automated Claims Review
- Experience in rule requirement Semi automated Claims Review.
- Experience in claims review, denials, coding validation
- 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
- Location: Jayanagar, Bangalore
- Mode: Work from Office
• 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! Our Commitment to Diversity: At CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose — regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.
From Coverself Benefits India's careers page (Keka), checked 1 Nov 2026.
How to apply
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Posted 1 Oct 2026 · checked 1 Nov 2026 · Report this job