Certified Medical Coder

Job Title: Certified Medical Coder

Location: Malad West, Mumbai

US Shift: 5:30 PM – 2:30 AM (Night Shift)

Job Overview: We are looking for a skilled and detail-driven Medical Coder to join our growing US Healthcare TPA operations. This role involves auditing and coding medical claims to ensure accuracy, benefit alignment, and compliance with federal and state healthcare regulations. The ideal candidate will play a critical part in maintaining claims processing quality, minimizing errors, and supporting the financial integrity of our third-party administration (TPA) services.

Key Responsibilities:

• Conduct pre-payment and concurrent audits of medical claims for self-funded and level-funded healthcare plans.
• Verify the accuracy of medical coding (ICD-10, CPT, HCPCS) and ensure correct application of plan benefits.
• Cross-reference claim codes with plan documents to determine appropriate benefit adjudication.
• Collaborate with claims examiners, supervisors, and compliance teams to identify and resolve discrepancies.
• Document and report audit findings with clarity and detail for internal review.
• Ensure all claims processing complies with HIPAA, ERISA, ACA, and other federal/state regulations.
• Participate in internal quality assurance programs and continuous process improvement initiatives.
• Maintain strict confidentiality of member and provider information.

Required Qualifications:

• Minimum 3 years of experience in medical claims coding and auditing within a US healthcare TPA or insurance environment.
• In-depth knowledge of medical coding systems (ICD-10, CPT, HCPCS) and healthcare claim forms (CMS-1500, UB-04).
• Solid understanding of regulatory compliance frameworks including HIPAA, ERISA, and ACA.
• Proficiency with auditing tools, claim processing systems, and Microsoft Office applications.
• Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS) certification is mandatory!
• Strong analytical, problem-solving, organizational, and communication skills.

Preferred Qualifications:

• Hands-on experience with claims adjudication platforms like Trizetto, VBA, Plexis.
• Prior experience in medical claims processing will be considered an added advantage.

Job Type: Full-time

Pay: ₹400,000.00 - ₹600,000.00 per year

Benefits:

• Health insurance
• Leave encashment
• Paid sick time
• Paid time off
• Provident Fund

Schedule:

• Fixed shift
• Monday to Friday
• Night shift
• US shift

Application Question(s):

• What is your current location?

Experience:

• Medical coding: 3 years (Preferred)
• Medical Auditing: 2 years (Preferred)

License/Certification:

• Medical Coding (Preferred)

Location:

• Malad, Mumbai, Maharashtra (Preferred)

Shift availability:

• Night Shift (Preferred)
• Overnight Shift (Preferred)

Work Location: In person