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The Role
The RCM Coding Specialist is a vital new role designed to make our team self-sufficient across the entire Revenue Cycle Management (RCM) cycle. This position serves as a Subject Matter Expert (SME), ensuring that medical coding is accurate, compliant, and optimized to reduce denials. You will bridge the gap between our global partners and US-based teams, providing the technical expertise necessary to improve patient outcomes and practice success.
What You’ll Do
Quality Assurance & Auditing (25%): Audit coding performed by Global Partners and provide timely feedback to resolve denied claims quickly.
Denial Management (20%): Review and resolve coding denials from payers, ensuring accurate resubmission and revenue recovery.
Subject Matter Expertise (20%): Act as the primary point of contact for coding questions and clarifications for the MMI team.
Trend Analysis (15%): Review claims assigned to practices due to coding issues to identify trends; collaborate with Client Advisors (CAs) when practice education or intervention is needed.
Preventive Strategy (10%): Analyze denial data to recommend preventive measures, such as scrub edits, provider training, and internal action plans.
Continuous Learning (5%): Stay current with Payer Guidelines and participate in ongoing coding educational opportunities and webinars.
Production Support (5%): Assist in production coding for various client specialties and scopes as needed.
What You Bring
Education & Certification: * Bachelor’s or Master’s degree in Human Science (Anatomy background), B.Sc, M.Sc, or B.Pharma.
CPC (AAPC) or CCS (AHIMA) certification is highly preferred.
Experience: * At least 5 years of overall experience in Provider RCM.
A minimum of 2 years of core experience as a QA or SME within a Coding Department.
Specialized Knowledge: * Expert-level knowledge in supplying, auditing, and analyzing CPT and ICD codes with appropriate modifiers.
Proven ability to resolve coding-related denials and a deep understanding of payer guidelines.
Strong coding knowledge in specialties including Gastroenterology, Orthopedics, Ophthalmology, Dermatology, and Podiatry.
Skills: * Excellent written and verbal English communication skills.
Ability to work independently and collaborate effectively across multiple countries.
Strong analytical skills with proficiency in MS Excel for reporting and trend analysis.
ModMed Benefits Highlight: At ModMed, we believe it’s important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:
Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
Allowances: Annual wellness allowance to support your well-being and productivity,
Earned, casual, and sick leaves to maintain a healthy work-life balance,
Bereavement leave for difficult times and extended medical leave options,
Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.
PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (first.lastname@modmed.com). Please check senders’ email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.
ModMed Technologies India Private Limited follows a strict, merit-based and transparent recruitment process conducted only through official and authorized channels.
We do not
Charge any fees, processing charges, or amount by any nomenclature, whether as a fee or deposit at any stage of the recruitment process;
Authorise any individual, employee, or third party to collect any such payments (regardless of nomenclature) to offer or facilitate or recruitment opportunities; or
Conduct hiring via informal messaging apps or personal email IDs.
All official communication is made only through verified channels, our website, and recognised recruitment platforms.
We strongly advise candidates not to share personal/financial information or make any payments in response to suspicious communications. Any such instances may be reported to us at hrcompliance@modmed.com .
ModMed Technologies India Private Limited will not be responsible for any loss arising from fraudulent or unauthorised communications.
