Carelon Global Solutions India
Website:
carelonglobal.in
Job details:
Position Title
Medical Coding - E&M - Sr Associate Medical Coding - GR - 40381-74831-1 - JR201209
Job Family
MED > Medical Ops & Support (Non-Licensed)
Shift
Job Description:
Job Title
Senior Associate - Medical Coding
Requirement Type
Full-Time Employee
Job Location
BLR/HYD
Requirement Level
Senior Associate
Hiring Manager
Team Lead
Primary Skill
Medical Coding - E&M
Business
HBHSO > Medical Coding
Skill Category
Generic
About Elevance Health
Elevance is a leading health company in America dedicated to improving lives and communities and making healthcare simpler. It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 45 million lives across 14 states.
A regular in Fortune 500 list, Elevance ranked 20 in 2022. Gail Boudreaux, President and CEO of Elevance has been a consistent name in the Fortune list of most powerful women and currently holds 4th rank on this list.
About Carelon
Carelon Global Solutions (CGS) is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.
Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health
(Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.
Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, Limerick in Ireland and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective and efficient.
OUR MISSION & VALUES
Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.
Our Values: Leadership | Community | Integrity | Agility | Diversity.
JOB POSITION
Primary role is to leverage specialized knowledge, providing guidance to team members, and directly assisting customers as an Individual Contributor. Your expertise will be instrumental in planning strategic procedures, improving work processes, and ensuring customer satisfaction. Active participation in learning programs, training sessions, and identifying business opportunities for revenue generation will be crucial to achieving the company's profitability goals.
JOB RESPONSIBILITY
- Review and code complex E&M encounters in accordance with coding and compliance guidelines.
- Analyze high-impact and complex denials, identify trends, and recommend corrective actions.
- Prepare and review appeals, reconsiderations, and supporting documentation for denied claims.
- Mentor associates and provide guidance on coding, denial management, and payer-specific requirements.
- Conduct quality reviews and assist in resolving coding and reimbursement-related queries.
- Maintain ongoing communication with management regarding coding workload, turnaround time expectations and deliverables.
- Monitor denial trends and support process improvement initiatives to reduce denial rates.
- Participate in client discussions, calibrations, and knowledge-sharing sessions.
- Maintains at least 95% accuracy in all coding projects by researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).
- Identify and correct any discrepancies in coding.
- Follow up with the payer on any documentation that is insufficient or unclear.
- Additional experience in facility (OPPS/IPPS) coding experience is preferred.
QUALIFICATION
- Bachelor’s degree from a recognized University equivalent that required 3+ years of formal studies.
- Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA.
Experience
- 2-3+ years proven experience in reviewing of clinical documents, assigning appropriate medical codes for diagnoses, procedures, and ensuring compliance with healthcare regulations and insurance requirements.
Skills And Competencies
- Review medical records and assign accurate diagnostic codes for HCC risk adjustment and Procedural coding.
- Strong knowledge on medical terminology, anatomy and Physiology.
- Adhere to coding guidelines and industry regulations (CMS, AMA, AHIMA, AAPC).
- Maintain compliance with HIPPA and other healthcare policies.
- Adaptable to change in business requirements
THE CARELON PROMISE
Aligning with our brand belief of ‘limitless minds are our biggest asset’, we offer a world of limitless opportunities to our associates.
It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.
This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.
LIFE @ CARELON
- Extensive focus on learning and development
- An inspiring culture built on innovation, creativity, and freedom.
- Holistic well-being
- Comprehensive range of rewards and recognitions
- Competitive health and medical insurance coverage
- Best-in-class amenities and workspaces
- Policies designed with associates at the center
EQUAL OPPORTUNITY EMPLOYER
Carelon is committed to a diverse and inclusive workplace and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.
Reasonable Accommodation
Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.
If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.
Disclaimer: Offered designation titles differ*
Job Type
Full time
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