📍 Hyderabad · ⏳ 2+ Years · 🎓 CPC Mandatory · 🚕 Cab Facility Available
🏥 About Vdart & the Role
Vdart Inc is a global technology and healthcare services company with operations across the US and India. In the US Healthcare space, Vdart provides Revenue Cycle Management (RCM), medical coding, billing, and payment integrity solutions for hospitals, clinics, and payers.
A Prepay Coding Investigation Consultant works on the front end of the claims process — reviewing medical records and codes before claims are processed/paid to identify unbundling, upcoding, incorrect modifier use, and other billing discrepancies that lead to overpayments. This is a specialized, high-value role in healthcare compliance.
⚡ Key Work Areas
📋 Roles & Responsibilities
Review medical claims and supporting clinical documentation before payment to identify coding errors, unbundling, upcoding, incorrect modifiers, and medically unnecessary services. Apply CPT, ICD-10-CM/PCS, and HCPCS Level II codes accurately based on medical record documentation.
Identify overpayments, duplicate billing, and billing compliance issues. Prepare detailed audit findings reports with supporting documentation. Coordinate with providers and clinical teams to clarify coding discrepancies. Ensure all reviews meet payer-specific and regulatory compliance standards (NCCI, LCD, NCD).
Review clinical documentation including operative reports, pathology reports, physician notes, and discharge summaries to validate coding accuracy. Document review findings in designated systems with clear audit trails. Apply clinical knowledge (RN/Pharmacist/Allied Health background preferred) to assess medical necessity.
Stay current with CMS guidelines, AMA CPT updates, and payer-specific policies. Meet daily/weekly productivity and quality metrics. Work in day or evening shift (8AM–5PM or 11AM–8PM IST). Cab facility is provided for shift-based work.
🎓 Eligibility & Skills
📩 How to Apply
Send your CV to anusuya.r@vdartinc.com. Subject line: "Prepay Coding Investigation Consultant – Hyderabad – [Your Name]"
