Seeking a highly detail-oriented and experienced Medical Coder to join our Revenue Cycle Management (RCM) team supporting a healthcare organization specializing in comprehensive clinical services and the 340B Pharmacy Program . The ideal candidate will be responsible for reviewing provider documentation, assigning accurate diagnosis and procedure codes, and ensuring compliance with coding standards, payer requirements, and regulatory guidelines.

This role requires a strong understanding of physician coding, preventive and chronic care services, laboratory coding, pharmacy-related documentation, and Federally Qualified Health Center (FQHC) billing practices. The successful candidate will play a critical role in maintaining coding accuracy, optimizing reimbursement, and minimizing compliance risks.

Key Responsibilities:

- Review and analyze clinical documentation to accurately assign ICD-10-CM, CPT, and HCPCS Level II codes.
- Ensure coding is compliant with CMS, Medicare, Medicaid, commercial payer guidelines, and organizational policies.
- Validate medical necessity and coding specificity to support accurate claim submission and reimbursement.
- Code services related to:
- Physician and Provider Office Visits
- Preventive and Annual Wellness Services
- Chronic Disease Management
- HIV/AIDS Clinical Services
- Laboratory Services
- Pharmacy and 340B Program documentation
- Identify documentation deficiencies and collaborate with providers to obtain necessary clarification.
- Support clean claim initiatives by minimizing coding-related denials and rework.
- Review and resolve coding edits, claim rejections, and payer denials related to coding accuracy.
- Maintain productivity and quality standards while meeting established turnaround times.




- Participate in internal coding audits and implement corrective actions based on audit findings.
- Stay current with annual coding updates, CMS regulations, National Correct Coding Initiative (NCCI) edits, and payer policy changes.
- Assist in educating providers and operational teams on documentation improvement and coding compliance.
- Collaborate with Billing, Accounts Receivable, Compliance, Clinical Operations, and Revenue Cycle teams to improve overall reimbursement performance.

Required Qualifications

- Minimum 1+ years of professional medical coding experience in a physician practice, multi-specialty clinic, FQHC, or Revenue Cycle Management environment.
- Strong knowledge of:
- ICD-10-CM
- CPT
- HCPCS Level II
- Modifier usage
- NCCI edits
- LCD/NCD guidelines
- CMS documentation requirements
- Experience coding physician evaluation and management (E/M) services.
- Robust understanding of medical terminology, anatomy, physiology, and pharmacology.
- Ability to interpret clinical documentation accurately and apply coding guidelines consistently.
- Excellent analytical, organizational, and communication skills.
- Proficiency in Microsoft Office applications, particularly Excel.

Preferred Qualifications

- Experience working with NextGen EHR and Practice Management systems.
- Prior experience supporting Federally Qualified Health Centers (FQHCs) .




- Knowledge of 340B Pharmacy Program documentation and billing workflows.
- Experience coding:
- Primary Care
- Internal Medicine
- Family Medicine
- Infectious Disease (HIV/AIDS)
- Preventive Medicine
- Laboratory Services
- Familiarity with quality reporting programs and value-based care documentation.
- Experience working with multiple payer types including Medicare, Medicaid, Managed Care, and Commercial Insurance.

Certifications (Required/Preferred) Candidates should possess one or more of the following industry-recognized certifications:

- CPC(Certified Professional Coder) AAPC (Preferred)

- CCS(Certified Coding Specialist) AHIMA

- CCA(Certified Coding Associate) AHIMA
- CCS-P(Certified Coding Specialist Physician-based) AHIMA (Highly Preferred)

Core Competencies

- Medical Coding Accuracy
- Revenue Cycle Management
- Clinical Documentation Review
- Coding Compliance
- Regulatory Knowledge (CMS, HIPAA, OIG)
- Critical Thinking and Problem Solving
- Quality Assurance
- Attention to Detail
- Time Management
- Team Collaboration
- Continuous Learning and Adaptability

Key KPIs The candidate will be expected to:

- Maintain a coding accuracy rate of 95% or higher .
- Meet established daily productivity and turnaround time expectations.
- Reduce coding-related claim denials and reimbursement delays.
- Demonstrate strong compliance with payer and regulatory requirements.
- Contribute to improved first-pass claim acceptance and overall Revenue Cycle performance.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Sr. Analyst Medical Coding (Bengaluru)
🏢 CONSERO
📍 Bengaluru