Medical Coders

Medical Coders

Company: Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO)

Location: Detroit, Tampa (State/Province: Florida, Maine) – posting start date 10/31/25

Wipro is seeking dedicated and detail‑oriented specialists who possess a Medical Coding Certificate and have a strong understanding of records review. They will handle appeals for Medicare members, specifically working on NCD/LCD denials, duplicate denials, and MUE denials requiring 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.

• Review medical record documentation supporting Evaluation and Management, CPT, HCPCS, and ICD‑10 code.
• Review company‑specific, CMS‑specific, and competitor‑specific medical policies, reimbursement policies, and editing rules; conduct clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Translate medical policies into reimbursement rules.
• Perform CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
• Coordinate research and respond to system inquiries and appeals.
• Conduct research of claims systems and system edits to identify adjudication issues and audit claims adjudication for accuracy.
• Perform pre‑adjudication claims reviews to ensure proper coding was used.
• Prepare correspondence to providers regarding coding and fee schedule updates.
• Train customer service staff on system issues.
• Work with providers contracting staff when new/modified reimbursement contracts are needed.

• High School diploma or equivalent.
• Previous WFH experience with ethernet/hard‑wired high‑speed internet.
• Medical coding certificate (CPC, CCS, or equivalent).
• Strong understanding of medical records review.
• Experience with Medicare appeals and denials (NCD/LCD, duplicate, MUE).
• Experience with Medicare denied claims review as an auditor/examiner.
• Knowledge of healthcare regulations and compliance.

• Life science and paramedic background.
• Knowledge of LCD vs. NCD differences with examples.
• Familiarity with software tools:
  Facets (Tri Zetto), Cosmos, Epic or others.
• Medicare appeals and denials: E & M coding, CPT coding, ICD‑10, HIPAA regulations.
• Forms: CMS‑1500, UB‑04 (CMS 1450), EDI 837, EDI 835, CARC (Claim Adjustment Reason Codes), RARC (Remittance Advice Remark Codes).

• Claims processing.

Expected compensation ranges from $25,000 to $50,000, depending on location, minimum wage obligations, skills, and relevant experience. The role is also eligible for Wipro’s standard benefits, including a full range of medical and dental benefits, disability insurance, paid time off (including sick leave), and additional paid and unpaid leave options.

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.

Wipro is 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. 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 and values diversity.