Job Title: Denial Medical Coder - US Healthcare (RCM / TPA / Claims Denials)
Location:
Malad West, Mumbai
Shift:
US Shift (6:30 PM - 3:30 AM, Night Shift)
Job Overview
We are seeking an experienced
Denial Medical Coder
to join our growing
US Healthcare TPA
operations. The ideal candidate will specialize in
denial management and resolution
, ensuring accurate coding, root cause analysis, and compliance with payer requirements. This role focuses on identifying coding-related denials, analyzing trends, and taking corrective actions to minimize future denials and improve first-pass claim rates.
This position is ideal for someone with a strong background in
denial coding, claim audits, and RCM operations
, who can bridge the gap between coding accuracy and revenue recovery.
Key Responsibilities:
Review and analyze
denied medical claims
to identify root causes related to coding, documentation, or payer policy.
Re-code, correct, and resubmit denied claims per payer-specific guidelines and coding standards.
Work closely with billing, audit, and AR (Accounts Receivable) teams to resolve coding-related denials.
Interpret and apply
ICD-10, CPT, HCPCS
, and
modifiers
to ensure compliant and accurate claim resubmissions.
Track and document
denial patterns and trends
to support process improvement initiatives.
Perform denial audits and recommend proactive strategies to reduce future denials.
Stay updated with payer policies, NCCI edits, and compliance requirements.
Maintain confidentiality and adhere to
HIPAA
and
US healthcare regulations
.
Candidate Expectations:
Deep understanding of
denial management workflows
within the RCM process.
Proficiency in
reading EOBs, CARC/RARC codes
, and identifying root causes of denials.
Solid grasp of coding combinations (CPT, ICD, POS, provider type, and specialty).
Ability to work independently with strong analytical and problem-solving skills.
Excellent communication and documentation skills.
Required Qualifications:
2-4 years
of experience in
Denial Medical Coding
or
Denial Management
for US healthcare claims.
Strong command of
ICD-10-CM, CPT, and HCPCS
coding.
Prior experience in
TPA, RCM, or healthcare payer environment
.
Familiarity with
claim forms
(CMS-1500 and UB-04).
Working knowledge of
HIPAA, ERISA, and payer-specific rules
.
Certifications such as
CPC, COC, CPMA, or CCS
preferred.
Proficiency in claim management tools and Microsoft Office applications.
Preferred Qualifications:
Experience in
denial analysis, AR follow-up, and re-coding of denied claims
.
Exposure to
claims adjudication systems
such as Trizetto, Facets or VBA.
Prior work experience with
US-based insurance payers or TPA setups
.
Why Join Us:
Work with a dynamic US healthcare TPA team specializing in denial management.
Opportunity to increase your expertise in
denial prevention and revenue recovery
.
Competitive compensation and night shift allowances.
Performance-based career advancement.
Job Type: Full-time
Pay: ₹400,000.00 - ₹600,000.00 per year
Benefits:
Health insurance
Leave encashment
Paid sick time
Paid time off
Provident Fund
Ability to commute/relocate:
Malad, Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (Preferred)
Application Question(s):
What's your current location?
Education:
Bachelor's (Preferred)
Experience:
Denial Medical Coding: 3 years (Preferred)
Location: