Opportunity Overview:

We are seeking a versatile and highly skilled Lead Claims Auditor to join our
dynamic Payment Integrity team. This critical role involves conducting
comprehensive professional and facility coding reviews—encompassing both
outpatient/professional and inpatient claims—to ensure the accuracy of code
assignment, DRG/reimbursement, and to maximize overpayment identification. If
you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and
ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you
will be instrumental in supporting our commitment to accurate reimbursement
solutions. This opportunity requires a self-motivated individual who thrives on
precision, compliance, and continuous learning in a high-growth environment

What you’ll do:

* Conduct comprehensive coding reviews to ensure accuracy in code assignment
and reimbursement. Conduct comprehensive outpatient and professional coding
reviews to ensure accuracy in code assignment and reimbursement. Apply expert




knowledge of coding guidelines and utilize industry-leading tools to maximize
overpayment identifications.
* Conduct ambulatory surgery center, emergency room, observation and infusion
coding reviews.
* Apply expert knowledge of coding guidelines and utilize industry-leading
tools to maximize overpayment identifications.
* Craft clear, concise, and well-supported audit findings, backed by AHA Coding
Clinic Guidelines and ICD-10-CM/PCS regulations.
* Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency
and accuracy in audits.
* Meet or exceed company quality and productivity standards, including solid
uphold rates for appeals.
* Stay ahead of industry trends, coding updates, and compliance regulations to
maintain expert-level knowledge.
* Adhere to HIPAA and company policies and procedures to ensure data security
and regulatory compliance.
* Maintain and apply superior knowledge of changes and updates to coding
guidelines,

📌 Lead Claims Auditor (Hyderabad)
🏢 Cohere Health
📍 Hyderabad