Job Summary

By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.

Advanced outpatient coding position that is responsible for reviewing all assigned work queues (charge, accounts, and claims edits) and for making all necessary corrections. Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process. Working knowledge of CPT codes, CCI & MUE edits, & other Medicare billing and charge capture rules.

Job Competencies

Valuing Differences - Works effectively with individuals of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds; seeks out and uses unique abilities, insights, and ideas. Considers the collective.

Collaboration - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success; focuses on the results of the team, not the achievements of one person. Its “All for One and One for All”.

Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone who is willing to step up and own it.

Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently.

Developing Trust - Gains others’ confidence by acting with integrity and following through on

Commitments. Treats others and their ideas with respect and supports them in the face of challenges.





Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required, is proactive and pursues relentlessly.

Essential Job Functions

Customer Obsession - Consistently provide exceptional experience for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

Embracing Current Ideas - Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

Striving for Excellence - Execute at a high level by demonstrating our “Best in KLAS” Ensemble

Difference Principles and consistently delivering outstanding results.

Denial Management & Edits:

- Analysing and resolving coding-related billing edits, such as National Correct Coding Initiative (NCCI) edits, Medically Unlikely Edits (MUE), and LCD/NCD rules.
- Reviewing denial trends by payer or department to find root causes, calculating financial impact, and recommending corrective actions to prevent future denials.

Charge Capture Optimization: Reviewing and auditing for missed or miscoded charges (CPT/HCPCS) to ensure accurate reimbursement.

Regulatory Compliance: Ensuring compliance with Medicare/Medicaid and other payer policies.





Data Analysis & Systems: Using EHR systems (e.g., Epic, Cerner, Meditech) and Excel-based tools to analyse reports and identify charge discrepancies.

Chargemaster Management: Updating and maintaining Charge Description Master (CDM) by updating CPT/HCPCS codes, revenue codes, and pricing to reflect current regulations.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.

Education, Certifications & Experience

Desired Expertise:

- Deep understanding of CPT/HCPCS coding systems, modifiers, hospital billing workflows, NCCI Edits, and insurance specific rules/guidelines.

- Experience with Injection/Infusion hierarchy and administration charges.

- Experience with reviewing level of services and appropriate CPT reporting based on documentation.

- Experience with both Hospital Based and Physician Based coding, insurance guidelines.

- Experience with EHR/EMR systems (Epic, Cerner, Athena), coding tools such as 3M, Encoder Pro.

Graduate in any discipline (B.Sc./M.Sc. Nursing, B. Pharm, M. Pharm, or Life Sciences preferred)

1 - 3 years of relevant experience in medical coding

Excellent knowledge of Epic, Excel and SQL queries.

Working knowledge of CPT & HCPCs coding guidelines.

Strong attention to detail and problem-solving skills is critical for the success of this role

📌 Specialist - Revenue Integrity (Telangana)
🏢 Orcapod Consulting Services
📍 Telangana