Job Title: Coding Auditor

Job Summary:
We are looking for a Coding Auditor to review medical records and claims in support of Fraud, Waste & Abuse (FWA) investigations and program integrity initiatives.

Key Responsibilities:
- Review medical records and claims for coding accuracy and potential fraud/waste/abuse.
- Prepare medical review summaries with transparent rationale for claim determinations.
- Conduct research related to investigations and medical coding.
- Identify suspicious patterns using coding guidelines, reimbursement methodologies, and healthcare regulations.
- Ensure compliance with federal/state policies and CMS/NCCI guidelines.
- Support special projects and maintain updated knowledge of coding standards.

Requirements:
- 2-5 years of relevant medical coding/auditing experience.
- CPC certification is mandatory.
- Knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDC and CMS/NCCI guidelines.
- Healthcare claims/FWA experience is preferred.
- Strong analytical, research, communication and attention-to-detail skills.
- Good knowledge of MS Office.
- Candidates should be willing to work in different shifts, including night shifts.

📌 Medical Coder (Pune)
🏢 Cotiviti
📍 Pune