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Medical Coding Trainee @ Angel And Genie

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 Medical Coding Trainee

Job Description

    Position Overview: This position plays a vital role within the Payment Integrity team by contributing to the development, enhancement, and maintenance of medical policy content. The role is responsible for converting healthcare guideline-driven concepts into system-readable configurations and performing comprehensive testing to ensure accuracy. Responsibilities include configuration and testing, ensuring adherence to industry standards, and collaborating with cross-functional teams to validate outputs and maintain quality. This role needs passionate people with good interpersonal, analytical & problem solving skills.

    • Having hands-on expertise in one or more of the following areas is an added advantage. 
    • Payment Integrity.
    • Clinical Coding.
    • Medical Coding.
    • Denials Management.

    Key Responsibilities:

    • Analyze and interpret concepts to ensure accurate configuration in line with medical coding, billing, and reimbursement guidelines.
    • Analyze medical coding, reimbursement guidelines and configure logic to support accurate concept execution.
    • Conduct in-depth reviews of contracts, policies, and federal/state regulations to formulate edit requirements.
    • Apply industry coding guidelines to claims processes effectively.
    • Demonstrate experience in analyzing and resolving coding issues for payment integrity purposes.
    • Analyze, develop, and implement system configurations.
    • Collaborate with subject matter experts (SMEs) and technical teams to translate regulatory and policy requirements into functional edit specifications.
    • Translate editing logic into platform configurations with support from SMEs, and stakeholders to ensure clear understanding and configuration of concepts.
    • Collaborate with cross-functional teams to assess configuration needs and implement appropriate solutions.
    • Assist in developing and maintaining payment integrity policies and procedures.
    • Review configurations to ensure completeness and accuracy based on the medical coding and billing guidelines.
    • Troubleshoot and perform root-cause analysis for edit logics not functioning as intended.
    • Effectively pinpoint configuration discrepancies and ensure concepts are deployed successfully and on schedule.
    • Audit and validate concepts against healthcare guidelines; identify and address gaps with upstream teams.
    • Conduct rigorous testing to verify concept accuracy and performance across outpatient, professional, and inpatient claim scenarios adhering to the coding guidelines.
    • Perform acceptance testing to validate configuration accuracy.
    • Stay updated with industry regulations and compliance requirements to ensure the configuration process adheres to relevant standards.
    • Perform duties independently with a high level of accuracy and professionalism.
    • Exhibit detail-oriented mindset with a focus on quality and accuracy in concept configuration & testing.
    • Familiarity with AI tools and prompt engineering to support medical content development, automation of policy logic, and Concept generation

    o Design and optimize prompts for large language models (LLMs) to generate accurate and clinically relevant medical content.

    o Experience in utilize AI tools (e.g., Gemini, NotebookLLM, ChatGPT, Claude, Perplexity, Grok, Bard, or custom LLMs) to assist in ideation, content creation, review, summarization, and validation.

    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.
    • Knowledge on policies like Medicare/Medicaid Reimbursement, Payer Payment Policies, NCCI, IOMs, CMS Policies etc.
    • Proficiency in Microsoft Word and Excel, with adaptability to new platforms.
    • Excellent verbal & written communication skills.
    • Excellent Interpretation and articulation skills.

    Qualifications: Education & Certification (one of the following required):

    • Bachelor of Science in Nursing (B.Sc. Nursing).
    • Pharmacist Degree (B.Pharm, M.Pharm or PharmD).
    • Life science Degree (Microbiology, Biotechnology, Biochemistry, etc).
    • Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc).
    • Other Bachelors Degree with relevant experience.

    Certification Requirements:

    • Candidates with certifications like CPC, CPMA, COC, CIC, CPC-P, CCS, or any specialty certifications from AHIMA or AAPC will be given preference.
    • Additional weightage will be given for AAPC specialty coding certifications.

    Experience:

    • 0-1 years of experience in Payment Integrity, Medical Coding, Denial Management.
    • Experience in payment integrity, claims processing, or related functions within the US healthcare system.
    • Experience in denial management, retrospective payment audits, or medical coding.
    • Familiarity with Medical coding guidelines, such as ICD, CPT, Modifiers, Medicare, Medicaid, or commercial payer guidelines.

    Work Location: Jayanagar Bangalore.

    Work Mode: Work from Office.

Employement Category:

Employement Type: Full time
Industry: Others
Role Category: Others
Functional Area: Not Specified
Role/Responsibilies: Medical Coding Trainee

Contact Details:

Company: Angel and Genie
Location(s): Bengaluru

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Keyskills:   denial management integrity coding medical

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Angel And Genie

Company Name : Angel and Genie Company Profile : Angel and Genie is an India based Recruitment Firm focused on providing Recruitment, Staffing and RPO Services to our Clients across the Globe. We have our Recruiters & Head Hunters based out of locations across India. Our Clientele include...