MedicalCodingAuditor(PaymentIntegrity)

**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 c