Job Overview
Location
Hyderabad, Telangana, India
Job Type
Full-time
Category
HR & Recruiting
Date Posted
March 24, 2026
Full Job Description
đź“‹ Description
- • The Sr Claims Auditor role is critical to Cohere Health’s Payment Integrity team, ensuring accurate reimbursement by conducting comprehensive professional and facility coding reviews across outpatient/professional and inpatient claims to identify overpayments and uphold compliance with coding and reimbursement standards.
- • This role directly supports Cohere Health’s mission to reduce healthcare waste, improve payer-provider collaboration, and ensure accurate, timely payments through AI-driven clinical and coding validation solutions like Cohere Validate™.
- • Day-to-day responsibilities include performing detailed audits of professional and facility claims, validating CPT, HCPCS, and ICD-10-CM/PCS code assignments, assessing DRG/reimbursement accuracy, and identifying coding errors or overpayment opportunities in commercial, marketplace, Medicare, and Medicaid claims.
- • The auditor will specialize in reviewing ambulatory surgery clinic claims, hospital observation claims, injection and infusion procedures, and high-cost drug or Durable Medical Equipment (DME) claims, applying deep expertise in coding guidelines and payment methodologies.
- • Using analytical skills, the auditor will interpret CMS NCDs/LCDs and clinical criteria where applicable, document findings clearly, and communicate discrepancies to stakeholders with precision and professionalism.
- • Collaboration is key: the auditor will work closely with cross-functional teams, including clinical, engineering, and product, to refine validation logic and support continuous improvement of Cohere Validate™’s AI-driven auditing capabilities.
- • The role demands self-direction and discipline in a remote/hybrid environment, requiring strong time management, independent problem-solving, and consistent delivery of high-quality audit outputs.
- • Continuous learning is expected—staying current with evolving coding guidelines, regulatory updates, and healthcare payment policies to maintain expert-level proficiency.
- • About the team and company: Cohere Health, backed by top-tier investors including Deerfield Management and Polaris Partners, serves over 660,000 providers and processes over 12 million prior authorizations annually, with its Payment Integrity Suite (enhanced by the ZignaAI acquisition) setting new standards in healthcare cost containment and transparency.
- • The company has been recognized on the 2025 Inc. 5000 list, featured in Gartner’s Hype Cycle for U.S. Healthcare Payers (2022–2025), and named a Top 5 LinkedIn Startup for 2023–2024, reflecting its rapid growth and innovation in responsible AI for healthcare.
- • Cohere Health fosters a culture of empathy, candor, kindness, and inclusivity, where diverse teams are valued and supported in a growth-oriented environment aligned with its core values.
- • In this role, the Sr Claims Auditor will develop deep expertise in healthcare payment integrity, gain exposure to cutting-edge AI applications in clinical validation, and contribute meaningfully to reducing systemic waste in the U.S. healthcare system.
- • The auditor will build leadership potential through ownership of complex audits, collaboration with senior stakeholders, and opportunities to influence product and process design in a high-impact, mission-driven organization.
🎯 Requirements
- • 3-5 years of overall experience in medical coding, auditing, or healthcare reimbursement.
- • Expert-level knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding guidelines, with deep understanding of outpatient and inpatient claims, including ambulatory surgery, observation, injection/infusion, high-cost drug, and DME claims.
- • Active CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
- • Bachelor’s degree required.
- • Superior understanding of U.S. healthcare payment methodologies for Commercial, Marketplace, Medicare, and Medicaid programs.
- • Excellent written and verbal English communication skills, strong analytical abilities, and meticulous attention to detail.
- • Proven ability to work independently and self-motivate in a remote environment while maintaining high performance and meeting deadlines.
🏖️ Benefits
- • Opportunity to work with a fast-growing, innovative healthcare technology company recognized on the Inc. 5000 list and Gartner’s Hype Cycle.
- • Exposure to cutting-edge AI-driven payment integrity solutions (Cohere Validate™) that are transforming healthcare economics and provider-payer collaboration.
- • Collaborative, inclusive culture rooted in core values of empathy, candor, kindness, and continuous learning, with investment in employee growth and development.
- • Remote-friendly work environment with flexibility, supported by a global team and modern collaboration tools.
- • Professional development support, including encouragement to pursue additional credentials like RHIA/RHIT and stay current with evolving coding and regulatory standards.
Skills & Technologies
Senior
Remote
Degree Required
About Cohere Health, Inc.
Cohere Health provides cloud-based software that automates prior authorization and care management workflows for health plans and providers. Its platform integrates clinical guidelines, payer rules, and EHR data to streamline approval processes, reduce administrative burden, and improve patient access to medically necessary care while lowering costs across the healthcare continuum.
Get more remote jobs like this
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
