Medical Coding Reimbursement Review Specialist Job at MMC Group LP

Medical Billing Specialist

We are seeking a dedicated and detail-oriented Medical Billing Specialist to joi...

Location

United States , Hagerstown

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent
Associate’s degree in Health Information Technology, Business Administration, or a related field is preferred
1+ years of experience in medical billing and accounts receivable, preferably within a healthcare setting
Strong knowledge of medical terminology, coding systems (CPT, ICD-10, HCPCS), and insurance regulations
Experience with medical billing software and electronic health records (EHR) systems
Excellent communication skills, both verbal and written
Detail-oriented with strong organizational and analytical skills
Ability to manage multiple priorities and meet deadlines in a fast-paced environment
Knowledge of HIPAA regulations and confidentiality requirements

Job Responsibility

Billing & Coding: Accurately review and submit medical claims to insurance companies, government programs (e.g., Medicare, Medicaid), and patients based on services provided
Accounts Receivable Management: Monitor and follow up on unpaid claims and accounts, ensuring timely resolution and payment collection
Claim Denial Management: Investigate and resolve denied or rejected claims, working with insurance providers to rectify issues and ensure proper reimbursement
Payment Posting: Post payments, adjustments, and denials to patient accounts accurately
Patient Communication: Communicate with patients and insurance companies to resolve billing inquiries, provide payment information, and answer any questions related to their accounts
Account Reconciliation: Ensure all accounts are reconciled and balanced, identifying discrepancies and making necessary adjustments
Compliance: Maintain up-to-date knowledge of relevant billing codes, insurance policies, and regulations to ensure compliance with industry standards and government regulations
Reporting: Generate and review accounts receivable reports, aging reports, and other billing data to ensure financial goals are met and identify areas for improvement
Collaboration: Work closely with the clinical and administrative teams to resolve any billing issues, discrepancies, or concerns

What we offer

Medical, vision, dental, and life and disability insurance
Company 401(k) plan
Access to top jobs
Competitive compensation

Fulltime

Medical Coding Review Specialist

We are seeking a highly motivated, detail-oriented Medical Coding Review Special...

Location

United States , Remote

Salary:

21.42 USD / Hour

MMC Group LP

Expiration Date

Until further notice

Requirements

Certified Medical Coder credential from a recognized organization such as AAPC, AHIMA, CPC, CCS
3 to 5 years of medical coding experience, preferably within reimbursement review, claims review, or retrospective coding environments
Strong experience with inpatient coding, CPT codes, CPT modifiers, retrospective coding reviews
Experience with IDRE and the ability to clearly explain the IDR process during the interview
Working knowledge of ICD-10-CM, CPT, HCPCS
Strong ability to read and interpret EOBs, claim adjustments, recoupments, and corrections
Excellent written communication skills, with the ability to draft professional and accurate determination letters
High attention to detail and commitment to accuracy and compliance
High School Diploma or GED required

Job Responsibility

Perform retrospective payment reimbursement reviews with a strong focus on coding accuracy and reimbursement analysis
Review and analyze inpatient coding scenarios, including CPT code application, modifiers, and reimbursement outcomes
Conduct retrospective coding reviews to ensure appropriate coding, billing accuracy, and payment determination support
Interpret and evaluate Explanations of Benefits, EOBs, including recoupments, corrections, denials, and other claim adjustments
Assess how CPT codes interact with one another and how modifiers impact reimbursement outcomes
Apply broad coding knowledge across multiple provider specialties
Support work related to the IDRE process, including accurate documentation and case review
Draft final and binding payment determination letters for distribution to clients and disputing parties
Maintain a high level of productivity, accuracy, and compliance in a deadline-sensitive environment

What we offer

Medical, dental, and vision coverage
Life and disability insurance
Additional voluntary benefits

Fulltime

Hb coding integrity specialist - outpatient denials

Reviews coded health information records to evaluate the quality of staff coding...

Location

United States

Salary:

28.55 - 42.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Specialist (CCS) certification issued by AHIMA
or Health Information Administrator (RHIA) registration issued by AHIMA
or Health Information Technician (RHIT) registration issued by AHIMA
Associate's Degree in Health Information Management or related field
Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions
Hospital Based Outpatient Surgery Coding Experience is required
Denials related experience is preferred
Demonstrated leadership skills and abilities
Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
Advanced knowledge in Microsoft Applications, including but not limited to

Job Responsibility

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition
Ensure accurate coding for outpatient, day surgery and inpatient records
Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded
Reviews encounters flagged for second level review, including but not limited to
hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership
Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance

Fulltime

Hb coding integrity specialist - inpatient denials

Reviews coded health information records to evaluate the quality of staff coding...

Location

United States

Salary:

28.55 - 42.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
Associate's Degree in Health Information Management or related field
Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions
Demonstrated leadership skills and abilities
Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions
Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
Advanced knowledge in Microsoft Applications, including but not limited to
Excel, Word, PowerPoint, Teams

Job Responsibility

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition
Ensure accurate coding for outpatient, day surgery and inpatient records
Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded
Reviews encounters flagged for second level review, including but not limited to
hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership
Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Opportunity for annual increases based on performance
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions

Fulltime

Hospital Coding Quality Specialist - Inpatient

Location

United States

Salary:

28.55 - 42.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
Associate's Degree in Health Information Management or related field
Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions
Demonstrated leadership skills and abilities
Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions
Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
Advanced knowledge in Microsoft Applications, including but not limited to
Excel, Word, PowerPoint, Teams

Job Responsibility

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition
Ensure accurate coding for outpatient, day surgery and inpatient records
Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded
Reviews encounters flagged for second level review, including but not limited to
hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership
Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Hb coding integrity specialist - inpatient denials

Reviews coded health information records to evaluate the quality of staff coding...

Location

United States

Salary:

28.55 - 42.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), or Health Information Administrator (RHIA) registration issued by AHIMA, or Health Information Technician (RHIT) registration issued by AHIMA
Associate's Degree in Health Information Management or related field
Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions
Demonstrated leadership skills and abilities
Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
Advanced knowledge in Microsoft Applications, including but not limited to
Excel, Word, PowerPoint, Teams
Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology.)
Advanced knowledge of pharmacology indications for drug usage and related adverse reactions
Expert knowledge of coding work flow and optimization of technology including how to navigate in the electronic health information record and in health information management and billing systems

Job Responsibility

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition
Ensure accurate coding for outpatient, day surgery and inpatient records
Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded
Reviews encounters flagged for second level review, including but not limited to
hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership
Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Hb coding integrity specialist - outpatient denials

Reviews coded health information records to evaluate the quality of staff coding...

Location

United States

Salary:

28.55 - 42.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by AHIMA
Health Information Technician (RHIT) registration issued by AHIMA
Associate's Degree in Health Information Management or related field
Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions
Demonstrated leadership skills and abilities
Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions
Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
Advanced knowledge in Microsoft Applications, including but not limited to
Excel, Word, PowerPoint, Teams

Job Responsibility

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition
Ensure accurate coding for outpatient, day surgery and inpatient records
Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded
Reviews encounters flagged for second level review, including but not limited to
hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership
Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Medical Billing Specialist

We are looking for a detail-oriented Medical Billing Specialist to support a hea...

Location

United States , Boca Raton

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 5 years of experience in medical billing, coding, collections, claims, or a closely related healthcare revenue cycle function
Demonstrated hands-on expertise with Evaluation and Management (E/M) coding
Proven experience performing documentation and coding audits in a healthcare setting
Strong understanding of payer policies, reimbursement methods, claim denials, and compliance requirements
Working knowledge of medical billing, medical coding, medical collections, medical claims, and ePaces
Current coding certification from a recognized accrediting organization is required.

Job Responsibility

Conduct secondary reviews of billing activity to confirm coding accuracy, regulatory compliance, and appropriate reimbursement outcomes
Examine clinical documentation to identify coding variances, prepare audit findings, and educate providers on documentation improvement opportunities
Collaborate with physicians and care teams to clarify incomplete or conflicting chart details and resolve documentation questions affecting claims
Escalate recurring documentation concerns, coding risks, and reimbursement patterns to revenue cycle leadership and practice management
Partner with billing and revenue staff to support account follow-up, claim corrections, and resubmissions that improve accounts receivable performance
Evaluate payer behavior, reimbursement trends, and policy updates to identify issues that may affect billing results or compliance
Investigate denials, coding questions, and billing-related inquiries, then provide clear guidance based on payer rules and compliance standards
Deliver training and day-to-day support to providers and less experienced staff on coding requirements, documentation standards, and regulatory expectations
Assist with updates to charge documents, workflows, and related procedures to maintain alignment with organizational and payer requirements
Protect the confidentiality of patient and financial information while completing assigned billing, coding, and audit activities.

What we offer

medical, vision, dental, and life and disability insurance
company 401(k) plan

Medical Coding Reimbursement Review Specialist

MMC Group LP

Location:
United States

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
May 16, 2026

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Medical Coding Reimbursement Review Specialist

MMC Group LP

Location:United States

Category:-

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:May 16, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

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Medical Billing Specialist

Location:
United States

Category:
-

Contract Type:
Not provided

Job Posted:
May 16, 2026