Claims Auditor – Payment Integrity

About the role

We are seeking a versatile and highly skilled Claims Auditor to join Cohere Health’s Payment Integrity team in Hyderabad. The role involves comprehensive professional and facility coding reviews of outpatient, professional, and inpatient claims to ensure accurate code assignment, DRG reimbursement, and to maximize overpayment identification.

Key responsibilities

• Conduct detailed coding reviews for outpatient, professional, ambulatory surgery center, emergency room, observation, and infusion claims.
• Apply expert knowledge of CPT, HCPCS, and ICD‑10‑CM/PCS guidelines and utilize industry‑leading tools to identify overpayments.
• Prepare clear audit findings supported by AHA Coding Clinic Guidelines and ICD‑10 regulations.
• Use advanced DRG encoder tools such as 3M and Webstrat to drive audit efficiency and accuracy.
• Maintain compliance with HIPAA, company policies, and stay current with coding updates and payment regulations.

Required profile

• 3–5 years of experience in medical coding and claims auditing.
• Self‑motivated professional able to work independently in a remote environment.
• Possess a CPC and/or CCS certification.
• Bachelor’s degree and excellent written and verbal English communication skills.

Required skills

• CPC or CCS certification.
• Proficiency with CPT, HCPCS, and ICD‑10‑CM/PCS coding guidelines.
• Experience using DRG encoder tools (e.g., 3M, Webstrat).
• Familiarity with CMS NCD/LCD clinical criteria guidelines.