Location: Jayanagar, Bangalore (Work from Office) Experience Required: Analyst: 3+ years (Budget upto 10 LPA) Team Lead: 5+ years (Budget upto 13 LPA) Manager: 10+ years (Budget up to 20 LPA) Sr. Manager: 13+ years (Budget up to 30 LPA) Key Responsibilities: Manage 13 end-to-end medical reimbursement payment policies (based on role level) Identify and implement rules to detect incorrect healthcare payments Analyze Medicare/Medicaid edits, coding guidelines, and reimbursement frameworks Translate clinical coding guidelines and industry references into actionable business logic Ensure coding compliance and maintain alignment with CMS and payer policies Collaborate across teams and operate independently Requirements: Strong expertise in Payment Integrity, Denials Logic & Management Deep knowledge of CPT, ICD, LCD/NCD, PTP, NCCI, modifiers, and billing guidelines Experience with claim forms (UB-04, CMS 1450, CMS 1500) Proficient in data analysis and deriving insights from CMS/Medicaid policies High attention to detail, adaptability, and strong communication skills Educational Qualification (any one): MBBS, BDS, BPT, BAMS, B.Sc. Nursing, PharmD, B.Pharm, M.Pharm Life Sciences (Microbiology, Biochemistry, etc.) Other relevant degrees with domain experience Certifications (Mandatory): Any of the following: CPC, CPMA, COC, CIC, CPC-P, CCS (AAPC or AHIMA) Additional AAPC specialty certifications and Lean Six Sigma preferred Key Skills: Medical Coding, Payment Integrity, RCM, CPT/HCPCS, ICD, DRG, Medicare/Medicaid policies, Data Analysis, MS Excel & Word, Communication Benefits: Competitive compensation Family health insurance & personal accident coverage Flexible leave policy Certification/course reimbursements Medical Coding CEUs and membership renewals Annual health checkups
