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This role is not for 2070 Health. 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 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 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 hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC. Additional weightage will be given for AAPC specialty coding certifications. Lean Six Sigma certification and practical application experience are preferred. Experience: Experience in Payment Integrity Content/Research, Semi automated Claims Review 3+ years experience for Analyst 5+ years experience for TL 10+ Years for Manager 13+ years for Senior Manager 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 Polici