Lead Claims Auditor – Payment Integrity

About the role

We are seeking a versatile and highly skilled Lead 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 maximize overpayment identification.

Key responsibilities

• Conduct comprehensive coding reviews for outpatient, professional, inpatient, ambulatory surgery center, emergency room, observation, and infusion claims to ensure accurate code assignment and reimbursement.
• Apply expert knowledge of CPT, HCPCS, and ICD‑10‑CM/PCS guidelines and utilize tools such as 3M Encoder and Webstrat to identify and maximize overpayment recoveries.
• Craft clear, concise audit findings supported by AHA Coding Clinic guidelines and maintain strong uphold rates for appeals.
• Stay current with industry trends, coding updates, and compliance regulations while ensuring HIPAA and company policy adherence.
• Assist the Information Security Manager with ISMS activities, implement security policies, and ensure team competence in information security.

Required profile

• 8–12 years of experience in coding and claims auditing with expert‑level knowledge of ICD‑10‑CM/PCS, CPT, and HCPCS.
• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credential.
• Bachelor’s degree.
• Proven ability to work independently in a remote environment while maintaining high performance.
• Strong analytical, problem‑solving, and time‑management skills.

Required skills

• CPT, HCPCS, ICD‑10‑CM/PCS coding guidelines.
• DRG encoder tools (e.g., 3M Encoder, Webstrat).
• CMS National and Local Coverage Determinations (NCD/LCD) criteria.
• Information security practices (ISMS).
• Proficiency with Mac OS.