Denial Medical Coder

Denial Medical Coder – US Healthcare (RCM / TPA / Claim Denials)

Malad West, Mumbai
US Night Shift | 6:30 PM – 3:30 AM

Job Summary:

We are hiring an experienced Denial Medical Coder to support our growing US Healthcare TPA/RCM operations. The ideal candidate will focus on resolving coding-related denials, analyzing trends, and ensuring compliance with payer guidelines. This role directly contributes to improving first-pass resolution and overall revenue cycle performance.

Key Responsibilities:

• Review denied medical claims and determine coding-, documentation-, or policy-related root causes.
• Correct and re-code claims based on ICD-10, CPT, HCPCS, and payer-specific rules.
• Coordinate with billing, auditing, and AR teams to resolve coding-driven denials.
• Track denial trends and provide actionable insights to improve denial prevention.
• Conduct denial audits and support continuous process improvements.
• Stay updated with NCCI edits, compliance changes, and payer policy updates.
• Maintain strict confidentiality and ensure HIPAA compliance at all times.

What You’ll Bring:

• Strong understanding of denial management processes within US RCM.
• Ability to read and interpret EOBs, CARC/RARC codes, and identify denial root causes.
• In-depth knowledge of coding combinations (ICD, CPT, POS, provider specialties, etc.).
• Strong analytical ability and problem-solving skills.
• Effective verbal and written communication skills.

Required Qualifications:

• 4-5 years of experience in Denial Coding or Denial Management for US Healthcare.
• Proficiency in ICD-10-CM, CPT, and HCPCS coding.
• Experience in TPA, RCM, or payer-side operations.
• Working knowledge of CMS-1500 and UB-04 claim forms.
• Understanding of HIPAA, ERISA, and payer guidelines.
• Preferred certifications: CPC, COC, CPMA, CCS.
• Familiarity with Microsoft Office and claim management tools.

Preferred Experience:

• Background in AR follow-up, denial analysis, and recoding denied claims.
• Experience with systems such as Trizetto, Facets, or VBA.
• Prior work experience with US insurance payers or TPA environments.

Why Work With Us?

• Opportunity to grow within a rapidly expanding US healthcare domain.
• Collaborative team environment with continuous learning opportunities.
• Role with direct impact on claim accuracy and revenue outcomes.

Apply Now

If you’re passionate about denial resolution, coding accuracy, and making an impact in the RCM process, we’d love to hear from you!

Job Type: Full-time

Pay: ₹700,000.00 - ₹1,000,000.00 per year

Benefits:

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

Ability to commute/relocate:

• Malad, Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (Preferred)

Application Question(s):

• What's your current location?
• Have you worked on coding-related claim denials, corrections, and re-submissions?

Experience:

• Denial Medical Coding: 4 years (Preferred)

Shift availability:

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

Work Location: In person