Medical Coder (Junior Payment Integrity)
Angel and Genie
Bengaluru, Karnataka, IndiaFresher1h agovia LinkedIn
About the Role
This role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.
Key Responsibilities
- Develop and maintain payment integrity rules, edits, and policies
- Translate Healthcare Payer guidelines into business rules
- Build code edit solutions to detect incorrect payments
- Conduct research on medical policies and reimbursement methodologies
- Support the configuration of payment integrity rules/solutions based on business requirements.
- Assist with testing configured rules and validating results to ensure expected outcomes.
Requirements & Tech Stack
- Strong research mindset with the ability to interpret clinical and medical literature
- Ability to convert clinical guidelines into logical rules
- Sound clinical knowledge with attention to detail and accuracy
- Excellent communication, articulation, and interpretation skills
- Ability to translate complex clinical information into clear and structured insights
Qualifications
Education & Certification (one of the following required):
- Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
- Nursing: Bachelor/Master of Science in Nursing
- Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
- Life Science - Bachelor/Master
Certification Requirements:
- Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.
Key Skills
- Strong analytical & interpretation skills
- 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 Details:
- Location: Jayanagar, Bangalore
- Mode: Work from Office