Lead Claims Auditor (QC)
HyderabadFull-time8–12 yrsPosted 4 months ago
Leadership audit role at Cohere Health in Hyderabad. Needs 8–12 years and a degree.
About the role
We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification.
What you'll do
- Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement
- Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement
- Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications
- Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews
- Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits
What you need
- Medical coding
- Audit
- Compliance