Senior Payment Integrity Analyst, US Healthcare - Surgery

CoverSelf empowers payers and providers with a truly NEXT-GEN cloud-native, holistic & customizable platform preventing and adapting to the ever-evolving claims & payment inaccuracies. Reduce complexity and administrative costs with a unified healthcare dedicated platform. We are backed by top VCs like BeeNext, 3One4 Capital and Saison Capital.

About the role:

We're looking for a deep domain expert/SME/domain leader who has good hands-on coding/payment integrity content/research/denials management experience in General, Neuro and cardiac surgeries. Experience in CDI, Denials Management and retrospective payment audits will be an added advantage.

Responsibilities:

• Identify, interpret, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on industry and guidelines experience, regulatory research, and ability to analyze medical claim data to discover incorrect claims.
• Owning medical reimbursement payment policies end to end.
• Development of Coding guidelines/Medicare/Medicare rules.
• Maintenance of the rules according to industry updates.
• Individual contributor role with or without team to report.

Requirements:

• Expertise in professional and or Facility surgery coding and billing guidelines with minimum 3 years hands on experience
• Extensive knowledge of denials logic from Payment Integrity, Revenue Integrity, Denials management.
• Solid knowledge and understanding of coding guidelines and medical code sets like CPT, ICD, indicator files, etc., Fee schedule, LCD/NCD, PTP, modifiers, coding conventions and rules.
• Experience with data collection, analysis, and good interpretation skills from literatures
• Strong analytical skills and ability to manage and report complex information.
• Ability to work in a fast-paced and dynamic work environment.
• Individual contributor who can work independently or with minimal guidance.
• Mind set of constant learning and six sigma mindsets of continuous improvement.
• Desire to grow professionally, develop new skills and willingness to work outside of my comfort zone.
• Fluency in Microsoft Word, Excel and adapting skills to new platforms.
• Excellent communication (verbal & written) skills is must
• Good analytical skills and effective stakeholder management.
• Exceptional interpersonal skills and demonstrated leadership abilities and abilities to collaborate with other team members and other departments and see themselves as unblockers
• Solution oriented/focused mindset to solve any challenges.
• Entrepreneurial at heart and likes to take ownership.

Certification requirements:

• Anyone of the following certifications is must
• CASCC, CCVTC, CGSC,COSC,CIRCC certifications have additional weightage
• CPC, CPMA, or COC or CPC-P certification
• Lean Six sigma (Implemented ideas in current roles) is preferable

Experience:

8+ years of experience in Payment Integrity Content/Research or Denial Management or Medical coding, should have knowledge on Reimbursement Payment Policies (Medical expertise is must).

Skill Sets:

Medical Coding, Medical Billing, Payment Integrity, US Healthcare, Revenue Cycle Management, Denials, Denial Management, CPC, CPC-P, COC, CPT Coding, ICD Coding, Medicare/Medicaid Reimbursement, Payment Policies, NCCI, IOMs, NCCI Manual, Anesthesia, Pain management, Surgery, Radiology, Path and Lab/laboratory and pathology.

Work Location: Bangalore

Work Mode: Work from office

Benefits: Best in the Industry Compensation, Health & Personal Accident Insurance, Friendly & Flexible Leave Policy, Certification & Courses Reimbursement and many more.

Additional Information:

At CoverSelf, we are creating a global workplace that enables everyone to find their true potential, purpose, and passion irrespective of their background, gender, race, sexual orientation, religion and ethnicity. We are committed to providing equal opportunity for all and believe that diversity in the workplace creates a more vibrant, richer work environment that advances the goals of our employees, communities and the business.