Medical Coding Or Denials, Research Policy Analyst To Senior Manager – Payment Integrity – Bangalore – 5-24l Ctc – 3-15yrs Exp

Analyst - 3 yrs - 5-8L - 4 openings TL - 5 yrs - 8-11L - 3 openings Manager - 10 yrs - 11-17L - 2 openings Senior Manager - 13 yrs - 17-24L - 2 openings Position Overview To play a critical role within the Content team contributing to the development enhancement and maintenance of medical policy content This position is responsible for researching new medical policies ensuring quality assurance and identifying opportunities to expand policy libraries This role will also conduct in-depth reviews of existing medical policies and support the development of clinical logic and algorithms We are seeking a passionate and experienced Subject Matter Expert SME with strong hands-on expertise in one or more of the following areas Payment Integrity Clinical Coding Analyst Content Development Payment Integrity Data mining Medical Coding Denials Management Specialty Expertise Candidates must have proficiency in coding and billing for one or more of the following specialties Evaluation Management E M Services Surgery Anesthesia Radiology Any Medical Coding Specialty Key Responsibilities Identify interpret develop and implement concepts to detect incorrect healthcare payments through regulatory research industry expertise and data analysis Analyst to support managing 1-2 medical reimbursement payment policies end-to-end Manager and above to manage 2-3 medical reimbursement payment policies end-to-end Develop and maintain coding guidelines Medicare Medicaid edits and reimbursement frameworks Analyze medical reimbursement methodologies including policy rules and edits Synthesize complex clinical and coding guidelines into actionable business logics Ensure compliance and update rules according to the latest industry standards Leverage expertise in medical coding healthcare claims processing and industry standards to support the development of clinical coding policies and edits Operate independently as an individual contributor Requirements Strong domain expertise in denials logic across Payment Integrity and Denials Management Solid understanding of medical coding billing methodologies and guidelines including CPT ICD LCD NCD PTP NCCI edits modifiers Medicare Physician fee schedule and coding conventions Proficiency in data collection analysis and deriving actionable insights from CMS medical policies Medicaid Provider Manuals and other Medical publications Translate industry references into actionable business logic to support new rules and policy enhancements Strong understanding of claim forms like UB-04 CMS 1450 and CMS 1500 Collaborate effectively across teams while managing multiple priorities Ability to thrive in a fast-paced dynamic environment with minimal supervision Demonstrated mindset for continuous learning and improvement and apply insights to policy development refinement and maintenance Strong stakeholder management interpersonal and leadership skills Solution-focused motivated entrepreneurial spirit with a strong sense of ownership Clear and effective communication Strong attention to accuracy and detail in all deliverables Qualifications Education Certification one of the following required Medical Degree e g MBBS BDS BPT BAMS etc Bachelor of Science in Nursing Pharmacist Degree B Pharm M Pharm or PharmD Life science Degree Microbiology Biochemistry etc Other Bachelor s Degree with relevant experience Certification Requirements Must hold any of the following certifications CPC CPMA COC CIC CPC-P CCS or any specialty certifications from AHIMA or AAPC Additional weightage will be given for AAPC specialty coding certifications Lean Six Sigma certification and practical application experience are preferred Experience Experience in Payment Integrity Content Research Denial Management or Medical Coding o 3 years experience for Analyst o 5 years experience for TL o 10 Years for Manager o 13 years for Senior Manager Experience in rule requirement gathering rule development and maintenance and Resolving payer denials In-depth knowledge of Reimbursement payment policies Medical coding Denial Management is required Key Skills Domain Expertise in US Healthcare Medical Coding Medical Billing Payment Integrity Revenue Cycle Management RCM Denials Management Codeset Knowledge like CPT HCPCS ICD Modifier DRG PCS etc Payment Policies knowledge like Medicare Medicaid Reimbursement Payer Payment Policies NCCI IOMs CMS Policies etc High proficiency in Microsoft Word and Excel with adaptability to new platforms Excellent verbal written communication skills Excellent Interpretation and articulation skills Strong analytical critical thinking and problem-solving skills Willingness to learn new products and tools Work Location Jayanagar - Bangalore Work Mode Work from Office Benefits Best-in-class compensation Health insurance for Family Personal Accident Insurance Friendly and Flexible Leave Policy Certification and Course Reimbursement Medical Coding CEUs and Membership Renewals Health checkup And many more