Medical Coders

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Wipro
Detroit, MAINE, United States (Remote)
25000 - 50000 USD / Year
  • Insurance
  • FullTime
  • Applications have closed

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  • Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
  • Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
  • Translates medical policies into reimbursement rules.
  • Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
  • Coordinates research and responds to system inquiries and appeals.
  • Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
  • Perform pre-adjudication claims reviews to ensure proper coding was used.
  • Prepares correspondence to providers regarding coding and fee schedule updates.
  • Trains customer service staff on system issues.
  • Works with providers contracting staff when new/modified reimbursement contracts are needed.

͏Basic Requirements and must haves:High School or equivalentPrevious WFH experience with ethernet/hard wired high-speed internet.Coding certificate (CPC, CCS, or equivalent)Strong understanding of medical records review.Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE).Must have experience with Medicare denied claims review as an auditor/examiner.Knowledge of healthcare regulations and compliancePreferred Skills:

  • Life science and Paramedic background

  • Difference between LCD and NCD with examples – (Local Claim Denial) and (National Claims Denial)

  • Software tools – Facets (TriZetto) , Cosmos, Epic or others

  • Medicare appeals and denials:

  • E & M coding

  • CPT coding

  • ICD 10

  • HIPPA regulations

  • Forms:

  • CMS- 1500

  • UB – 04 (CMS 1450)

  • EDI 837

  • EDI 835

  • CARC – Claim Adjustment Reason Codes

  • RARC – Remittance Advice Remark Codes

Mandatory Skills: Claims_Processing .The expected compensation for this role ranges from $25,000 to $50,000 .Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law.Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome.Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA – as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention.Apply nowStart Please wait…Information at a GlanceGet Job AlertsReceive notifications when we have open roles and get other relevant career newsJoin UsExplore open roles that match your interests and skillsIf you encounter any suspicious mail, advertisements, or persons who offer jobs at Wipro, please email us at . Do not email your resume to this ID as it is not monitored for resumes and career applications.Any complaints or concerns regarding unethical/unfair hiring practices should be directed to our Ombuds Group at .We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law.Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity.© 2025 Wipro Limited×Cookie Consent ManagerWhen you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. Because we respect your right to privacy, you can choose not to allow some types of cookies. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.Required CookiesThese cookies are required to use this website and can’t be turned off. DetailsRequired Cookies Provider Description Enabled
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