Medical Coding Trainee
- Angel And Genie
- 1 Positions
- Bengaluru
- 11 days ago
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Job Description
- Having hands-on expertise in one or more of the following areas is an added advantage.
- Payment Integrity.
- Clinical Coding.
- Medical Coding.
- Denials Management.
- 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
- 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.
- 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.
- 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.
- 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.
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.
Key Responsibilities:
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:
Qualifications: Education & Certification (one of the following required):
Certification Requirements:
Experience:
Work Location: Jayanagar Bangalore.
Work Mode: Work from Office.
Employement Category:
Employement Type: Full timeIndustry: OthersRole Category: OthersFunctional Area: Not SpecifiedRole/Responsibilies: Medical Coding TraineeContact Details:
Company: Angel and GenieLocation(s): Bengaluru
Keyskills: denial management integrity coding medical
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