Job Summary:
CoverSelf is hiring experienced professionals for roles ranging from Analyst to Manager within its Payment Integrity team in Bangalore. If you have a strong background in Outpatient Facility Medical Coding, Denials Management, and US Healthcare Policy Analysis, this is a golden opportunity to contribute to cutting-edge Payment Integrity platforms. Apply your expertise in coding, reimbursement frameworks, and denial resolution while shaping next-generation healthcare claim accuracy.
Key Responsibilities:
Research, develop, and maintain medical policy content for Payment Integrity.
Conduct quality assurance and identify expansion opportunities for policy libraries.
Manage 1-3 reimbursement payment policies based on experience level.
Interpret and develop concepts to detect incorrect healthcare payments.
Analyze reimbursement methodologies and clinical guidelines.
Synthesize complex coding standards into executable business logic.
Ensure all configurations comply with Medicare, Medicaid, and payer policies.
Collaborate with SMEs, technical teams, and stakeholders.
Utilize AI tools (ChatGPT, Gemini, Bard, Claude, etc.) for content generation and validation.
Conduct root cause analysis, policy development, and enhancement.
Perform independent, detail-oriented research and policy maintenance.
Required Skills & Qualifications:
Strong expertise in US Healthcare Medical Coding, Billing, Payment Integrity, Denials Management, and Revenue Cycle Management (RCM).
Knowledge of CPT/HCPCS, ICD, Modifiers, DRG, PCS coding systems.
Familiarity with reimbursement policies: Medicare, Medicaid, CMS, NCCI edits, IOMs.
Proficiency in Microsoft Word, Excel; adaptability to new platforms.
Excellent analytical, problem-solving, and communication skills.
Strong interpretation and articulation of coding & billing policies.
Hands-on with AI tools and prompt engineering for medical content.
Education & Certifications (Any One Required):
Medical Degree (MBBS, BDS, BPT, BAMS, etc.)
Bachelor’s in Nursing, Pharmacy (B.Pharm, M.Pharm, PharmD), or Life Sciences (Microbiology, Biochemistry)
Any graduate with relevant experience
Mandatory Certifications: CPC, CPMA, COC, CIC, CPC-P, CCS (AAPC or AHIMA)
Preferred: AAPC Specialty Coding Certifications, Lean Six Sigma
Experience:
Analyst: 3+ years
Team Lead: 5+ years
Manager: 10+ years
Senior Manager: 13+ years
Experience in denial management, coding guidelines, claim forms (UB-04, CMS 1500), policy research, and payment integrity rule development is essential.
Perks & Benefits:
Best-in-class competitive salary
Comprehensive family health insurance
Personal accident insurance coverage
Flexible and friendly leave policy
Course & certification reimbursement (AAPC, AHIMA, CEUs)
Annual health checkups
Inclusive and diverse workplace environment
Company Description:
CoverSelf is a pioneering, cloud-native healthcare platform that simplifies US healthcare payment integrity processes. Backed by top venture capitalists, CoverSelf aims to improve claims accuracy and reduce administrative burdens for payers through AI-driven innovation.
Work Mode:
On-site (Jayanagar, Bangalore)
Call to Action:
Ready to make an impact in healthcare payment integrity and medical coding? Apply now and become part of CoverSelf’s cutting-edge Payment Integrity team in Bangalore!.
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