Denial Medical Coder

Job Title: Denial Medical Coder – US Healthcare (RCM / TPA / Claims Denials)

Location: Malad West, Mumbai
Shift: US Shift (6:30 PM – 3:30 AM, Night Shift)

Job Overview

We are seeking an experienced Denial Medical Coder to join our growing US Healthcare TPA operations. The ideal candidate will specialize in denial management and resolution, ensuring accurate coding, root cause analysis, and compliance with payer requirements. This role focuses on identifying coding-related denials, analyzing trends, and taking corrective actions to minimize future denials and improve first-pass claim rates.

This position is ideal for someone with a strong background in denial coding, claim audits, and RCM operations, who can bridge the gap between coding accuracy and revenue recovery.

Key Responsibilities:

• Review and analyze denied medical claims to identify root causes related to coding, documentation, or payer policy.
• Re-code, correct, and resubmit denied claims per payer-specific guidelines and coding standards.
• Work closely with billing, audit, and AR (Accounts Receivable) teams to resolve coding-related denials.
• Interpret and apply ICD-10, CPT, HCPCS, and modifiers to ensure compliant and accurate claim resubmissions.
• Track and document denial patterns and trends to support process improvement initiatives.
• Perform denial audits and recommend proactive strategies to reduce future denials.
• Stay updated with payer policies, NCCI edits, and compliance requirements.
• Maintain confidentiality and adhere to HIPAA and US healthcare regulations.

Candidate Expectations:

• Deep understanding of denial management workflows within the RCM process.
• Proficiency in reading EOBs, CARC/RARC codes, and identifying root causes of denials.
• Solid grasp of coding combinations (CPT, ICD, POS, provider type, and specialty).
• Ability to work independently with strong analytical and problem-solving skills.
• Excellent communication and documentation skills.

Required Qualifications:

• 2–4 years of experience in Denial Medical Coding or Denial Management for US healthcare claims.
• Strong command of ICD-10-CM, CPT, and HCPCS coding.
• Prior experience in TPA, RCM, or healthcare payer environment.
• Familiarity with claim forms (CMS-1500 and UB-04).
• Working knowledge of HIPAA, ERISA, and payer-specific rules.
• Certifications such as CPC, COC, CPMA, or CCS preferred.
• Proficiency in claim management tools and Microsoft Office applications.

Preferred Qualifications:

• Experience in denial analysis, AR follow-up, and re-coding of denied claims.
• Exposure to claims adjudication systems such as Trizetto, Facets or VBA.
• Prior work experience with US-based insurance payers or TPA setups.

Why Join Us:

• Work with a dynamic US healthcare TPA team specializing in denial management.
• Opportunity to increase your expertise in denial prevention and revenue recovery.
• Competitive compensation and night shift allowances.
• Performance-based career advancement.

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

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?

Education:

• Bachelor's (Preferred)

Experience:

• Denial Medical Coding: 3 years (Preferred)

Location:

• Malad, Mumbai, Maharashtra (Preferred)

Shift availability:

• Overnight Shift (Required)
• Night Shift (Required)

Work Location: In person