Medical Coders

Req Id: 106826

City: Detroit, Tampa

State/Province: Florida, Maine

Posting Start Date: 10/31/25

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.

Job Description:

Job Description

Wipro is seeking dedicated and detail-oriented specialists who possess a Medical Coding Certificate and have a strong understanding of records review. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials needing E & M outpatient CPT Coding. The role involves reviewing medical records, comparing findings to CMS guidelines, and determining if conditions of coverage exist. If conditions are not met, the specialist will provide an uphold justification

Responsiblities

• 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 equivalent
  
  Previous 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 compliance

Preferred 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.

Client-provided location(s): Waterville, ME

Job ID: Wipro-106826

Employment Type: OTHER

Posted: 2025-11-01T18:41:38