Medical Coding Auditor (Payment Integrity)

**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.

**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

• 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
• 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 environment 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
• Must be CPC Certified
• Additional weightage will be given for AAPC specialty coding certifications.
• Lean Six Sigma certification and practical application experience are preferred.