Medical Coding Specialist

Job Title: Medical Coding Specialist

Location: Malad West, Mumbai
Shift: US Shift (5:30 PM – 2:30 AM, Night Shift)

Job Overview:
We are seeking an experienced Medical Coding Specialist to join our dynamic US Healthcare TPA operations. In this role, you will be responsible for auditing and coding medical claims to ensure accuracy, compliance, and proper benefit application. Your expertise will directly support high-quality claims processing, reduce errors, and safeguard the financial integrity of our third-party administration services.

Responsibilities:
You will be responsible for performing pre-payment and concurrent audits of medical claims for self-funded and level-funded healthcare plans. You will review and validate medical coding (ICD-10, CPT, HCPCS) while ensuring claims are adjudicated correctly according to plan provisions. You will cross-reference claim codes with plan documents, collaborate with examiners, supervisors, and compliance teams to resolve discrepancies, and prepare detailed audit reports for internal stakeholders. You will also ensure strict adherence to HIPAA, ERISA, ACA, and other federal and state regulations, while maintaining confidentiality of member and provider information. Additionally, you will contribute to internal quality assurance programs and continuous improvement initiatives to strengthen claims accuracy and compliance.

Required Qualifications:

• 2–3 years of experience in medical claims coding and auditing in a US Healthcare TPA or insurance environment.
• Strong knowledge of medical coding systems (ICD-10, CPT, HCPCS) and healthcare claim forms (CMS-1500, UB-04).
• Understanding of HIPAA, ERISA, ACA, and related regulatory compliance frameworks.
• Proficiency in claims auditing tools, adjudication systems, and Microsoft Office.
• Mandatory certifications such as CPC, CPMA, or CCS.
• Excellent analytical, organizational, and communication skills.

Preferred Qualifications:

• Experience with platforms such as Trizetto, VBA, or Plexis.
• Prior exposure to medical claims processing will be an added advantage.

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)

Experience:

• Medical coding: 2 years (Preferred)

License/Certification:

• CPC or Medical certification (Preferred)

Location:

• Malad, Mumbai, Maharashtra (Preferred)

Shift availability:

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

Work Location: In person