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:
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Strong expertise in Medical Coding & RCM processes
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Hands-on experience in claims audit and validation
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Understanding of coding guidelines, billing workflows, and compliance
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Strong domain expertise Semi automated Claims review
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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.
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Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals and other Medical publications.
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Translate industry references into actionable business logic to support new rules and policy enhancements.
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Strong understanding of claim forms like UB-04/CMS 1450 and CMS 1500
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Collaborate effectively across teams while managing multiple priorities
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Ability to thrive in a fast-paced, dynamic environment with minimal supervision.
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Demonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement and maintenance.
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Strong stakeholder management, interpersonal, and leadership skills.
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Solution-focused, motivated, entrepreneurial spirit with a strong sense of ownership.
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Clear and effective communication.
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Strong attention to accuracy and detail in all deliverables
Qualifications
Education & Certification (one of the following required):
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Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
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Nursing: Bachelor/Master of Science in Nursing
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Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
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Life Science -Bachelor/Master
Certification Requirements:
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Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.
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Additional weightage will be given for AAPC specialty coding certifications.
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Lean Six Sigma certification and practical application experience are preferred.
Experience:
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Experience in Payment Integrity Content/Research, Semi automated Claims Review
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3+ years experience for Analyst
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5+ years experience for TL
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10+ Years for Manager
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13+ years for Senior Manager
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Experience in rule requirement Semi automated Claims Review.
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Experience in claims review, denials, coding validation
Key Skills:
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Medical Coding (CPT, ICD, HCPCS)
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Claims Audit & Validation
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RCM & Denials Management
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Knowledge of NCCI edits, modifiers
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Nurse claims Review
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Attention to detail & analytical skills
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Domain Expertise in US Healthcare Medical Coding, Medical Billing, Payment Integrity, Revenue Cycle Management (RCM), Denials Management.
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Codeset Knowledge like CPT/HCPCS, ICD, Modifier, DRG, PCS, etc.
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Payment Policies knowledge like Medicare/Medicaid Reimbursement, Payer Payment Policies, NCCI, IOMs, CMS Policies etc
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High proficiency in Microsoft Word and Excel, with adaptability to new platforms.
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Excellent verbal & written communication skills.
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Excellent Interpretation and articulation skills
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Strong analytical, critical thinking, and problem-solving skills
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Willingness to learn new products and tools
Work Details:
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Location: Jayanagar, Bangalore
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Mode: Work from Office
Benefits:
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Best-in-class compensation
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Health insurance for Family
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Personal Accident Insurance
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Friendly and Flexible Leave Policy
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Certification and Course Reimbursement
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Medical Coding CEUs and Membership Renewals
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Health checkup
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And many more!
