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
• Strong expertise in Medical Coding & RCM processes
• Hands-on experience in claims audit and validation
• Understanding of coding guidelines, billing workflows, and compliance
• Strong domain expertise Semi automated Claims review
• 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.
• Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies,



Medicaid Provider Manuals and other Medical publications.
• Translate industry references into actionable business logic to support new rules and policy enhancements.
• Strong understanding of claim forms like UB-04/CMS 1450 and CMS 1500
• Collaborate effectively across teams while managing multiple priorities
• Ability to thrive in a fast-paced, dynamic setting with minimal supervision.
• Demonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement and maintenance.
• Strong stakeholder management, interpersonal, and leadership skills.
• Solution-focused, motivated, entrepreneurial spirit with a strong sense of ownership.
• Clear and effective communication.
• Strong attention to accuracy and detail in all deliverables Qualifications Education & Certification (one of the following required):
• Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
• Nursing: Bachelor/Master of Science in Nursing
• Pharmacist Degree (B.
Pharm, M.
Pharm or PharmD)
• Life Science -Bachelor/Master Certification Requirements
• Must be CPC Certified
• Additional weightage will be given for AAPC specialty coding certifications.
• Lean Six Sigma certification and practical application experience are preferred. Experience
• 1-3 Experience in Payment Integrity Content/Research, Semi automated Claims Review




• Experience in rule requirement Semi automated Claims Review.
• Experience in claims review, denials, coding validation Key Skills
• Medical Coding (CPT, ICD, HCPCS)
• Claims Audit & Validation
• RCM & Denials Management
• Knowledge of NCCI edits, modifiers
• Nurse claims Review
• Attention to detail & analytical skills
• Domain Expertise in US Healthcare Medical Coding, Medical Billing, Payment Integrity, Revenue Cycle Management (RCM), Denials Management.
• Codeset Knowledge like CPT/HCPCS, ICD, Modifier, DRG, PCS, etc.
• Payment Policies knowledge like Medicare/Medicaid Reimbursement, Payer Payment Policies, NCCI, IOMs, CMS Policies etc
• High proficiency in Microsoft Word and Excel, with adaptability to new platforms.
• Excellent verbal & written communication skills.
• Excellent Interpretation and articulation skills
• Strong analytical, critical thinking, and problem-solving skills
• Willingness to learn new products and tools Work Details
•

Location:
Jayanagar, Bangalore
• Mode: Work from Office Benefits
• Best-in-class compensation
• Health insurance for Family
• Personal Accident Insurance
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• Health checkup
• And many more Our Commitment To Diversity At CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose — regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.

📌 Medical Coding Auditor/Denial Coders (Bengaluru)
🏢 CoverSelf
📍 Bengaluru