Associate Medical Coder

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.

Job Responsibility:

• Review medical documentation and assign appropriate E&M CPT codes based on AMA and CMS guidelines.
• Analyze Medical Decision Making (MDM), time-based services, and documentation requirements.
• Review denied claims to identify root causes and determine corrective actions.
• Ensures project activities are in compliance with applicable coding guidelines, government and federal regulations.
• Research payer policies and coding guidelines related to denials
• Ensure compliance with HIPAA, regulatory requirements, and client-specific guidelines.
• Maintain ongoing communication with management regarding coding workload, turnaround time expectations and deliverables.
• Escalate complex coding or denial issues to leadership when necessary
• 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).

Experience:

• 1-2 Yrs proven experience in reviewing of clinical documents, assigning appropriate medical codes for diagnoses, procedures, and ensuring compliance with healthcare regulations and insurance requirements.