Medical Coding Reimbursement Review Specialist Job at MMC Group LP

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

Medical Coding Specialist

The Medical Coding Specialist is responsible for obtaining charge capture data f...

Location

United States , Salina

Salary:

Not provided

Central Care Cancer Center

Expiration Date

Until further notice

Requirements

Previous clinical or coding experience
At least 2 years’ experience of medical billing in a Healthcare setting and CPC, required
CEMC, CPMA, and CHONC certifications preferred
Knowledge of CPT and ICD10 coding
Knowledge of HIPAA and OSHA rules and regulations
Knowledge of insurance fee schedules and contractual obligations
Problem Solving
Maintains confidentiality
Balances team and individual responsibilities
Displays willingness to make decisions

Job Responsibility

Obtaining charge capture data from the electronic medical records (EMR) and keying this information into the patient management system daily for multiple assigned locations
Review medical notes and records to identify proper coding of claims
Assigns and translate codes for different services and diagnosis
Review physicians’ notes and charts for accuracy
Maintain current knowledge of coding and keep current with medical compliance and reimbursement policies impacting claims payments
Responsible for daily entering and organizing of codes from EMR into billing management software
Familiar with ICD10 and CPT/HCPCS universal coding systems
Obtains necessary clarification with clinical managers and nursing staff to ensure appropriate billing and charge capture
Manage and track missing charge capture reports or billing information, ensuring timely entry of information prior to month end
Monthly audit of assigned locations (10% of charts)

Fulltime

Surgery Medical Coding Specialist

We are seeking a detail-oriented Surgery Medical Coder to join our team. This ro...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High School Diploma or GED required
1–2 years of related experience required
One of the following certifications is required: Certified Professional Coder (CPC), Certified Coding Specialist – Physician-based (CCS-P), Certified Orthopaedic Surgery Coder (COSC)

Job Responsibility

Review and accurately code surgical procedures, diagnoses, and related services
Ensure coding compliance with payer, regulatory, and organizational guidelines
Analyze medical documentation to assign appropriate CPT, ICD-10, and HCPCS codes
Work closely with providers and staff to clarify documentation as needed
Maintain productivity and accuracy standards in a remote work environment
Support billing and reimbursement processes through precise code assignment
Participate in minimal onsite training sessions and periodic team meetings

What we offer

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

Fulltime

Medical Coding Specialist

The Medical Coding Specialist is responsible for obtaining charge capture data f...

Location

United States , Salina

Salary:

Not provided

Central Care Cancer Center

Expiration Date

Until further notice

Requirements

Previous clinical or coding experience
At least 2 years’ experience of medical billing in a Healthcare setting and CPC, required
CEMC, CPMA, and CHONC certifications preferred
Knowledge of CPT and ICD10 coding
Knowledge of HIPAA and OSHA rules and regulations
Knowledge of insurance fee schedules and contractual obligations
Problem Solving
Maintains confidentiality
Balances team and individual responsibilities
Displays willingness to make decisions

Job Responsibility

Obtain charge capture data from the electronic medical records (EMR) and key this information into the patient management system daily for multiple assigned locations
Review medical notes and records to identify proper coding of claims
Assign and translate codes for different services and diagnosis
Review physicians’ notes and charts for accuracy
Maintain current knowledge of coding and keep current with medical compliance and reimbursement policies impacting claims payments
Responsible for daily entering and organizing of codes from EMR into billing management software
Familiar with ICD10 and CPT/HCPCS universal coding systems
Obtain necessary clarification with clinical managers and nursing staff to ensure appropriate billing and charge capture
Manage and track missing charge capture reports or billing information, ensuring timely entry of information prior to month end
Monthly audit of assigned locations (10% of charts)

Fulltime

New

Inpatient Coding Specialist

We are looking for an Inpatient Coding Specialist to support accurate inpatient ...

Location

United States , Sacramento

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Hands-on experience coding inpatient medical records in a healthcare, hospital, or revenue cycle environment
Working knowledge of inpatient diagnosis and procedure coding standards, reimbursement groupers, and official coding guidance
Ability to interpret complex clinical documentation and abstract required information with a high level of accuracy
Familiarity with regulatory and payer requirements related to coding, billing, compliance, and data reporting
Proficiency with electronic health records and coding support tools, including systems such as Epic and 3M software
Strong communication skills with the ability to collaborate with providers, documentation specialists, and revenue cycle teams
Effective time management and organizational skills to balance productivity goals, queue management, and quality expectations
Detail-oriented approach with the ability to perform audits, verification activities, and independent problem-solving

Job Responsibility

Examine inpatient charts and translate clinical documentation into accurate diagnosis and procedure codes using applicable classification systems and grouping methodologies
Determine the appropriate reimbursement grouping for each account while confirming discharge status, admission source details, and present-on-admission indicators are recorded correctly
Abstract required clinical and demographic data elements according to facility guidelines and regulatory reporting expectations
Review physician and care team documentation for completeness, identify missing or conflicting information, and pursue clarification when needed to support code assignment
Manage discharged-not-billed work queues to help move accounts through the revenue cycle within established turnaround expectations
Partner with clinical documentation improvement staff and providers to strengthen record completeness and support accurate severity and reimbursement outcomes
Apply coding, billing, and data collection rules consistently to maintain compliance with state, federal, and payer requirements
Use coding and validation tools such as Epic, 3M applications, encoders, audit platforms, and standard office software to verify information and complete assigned work
Maintain productivity and quality benchmarks while working independently, organizing priorities effectively, and resolving issues that affect coding accuracy or timeliness

What we offer

medical insurance
vision insurance
dental insurance
life insurance
disability insurance
401(k) plan

New

Inpatient Coding Specialist

We are looking for an Inpatient Coding Specialist to support accurate inpatient ...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Hands-on experience coding inpatient medical records in a healthcare, hospital, or revenue cycle environment
Working knowledge of inpatient diagnosis and procedure coding standards, reimbursement groupers, and official coding guidance
Ability to interpret complex clinical documentation and abstract required information with a high level of accuracy
Familiarity with regulatory and payer requirements related to coding, billing, compliance, and data reporting
Proficiency with electronic health records and coding support tools, including systems such as Epic and 3M software
Strong communication skills with the ability to collaborate with providers, documentation specialists, and revenue cycle teams
Effective time management and organizational skills to balance productivity goals, queue management, and quality expectations
Detail-oriented approach with the ability to perform audits, verification activities, and independent problem-solving

Job Responsibility

Examine inpatient charts and translate clinical documentation into accurate diagnosis and procedure codes using applicable classification systems and grouping methodologies
Determine the appropriate reimbursement grouping for each account while confirming discharge status, admission source details, and present-on-admission indicators are recorded correctly
Abstract required clinical and demographic data elements according to facility guidelines and regulatory reporting expectations
Review physician and care team documentation for completeness, identify missing or conflicting information, and pursue clarification when needed to support code assignment
Manage discharged-not-billed work queues to help move accounts through the revenue cycle within established turnaround expectations
Partner with clinical documentation improvement staff and providers to strengthen record completeness and support accurate severity and reimbursement outcomes
Apply coding, billing, and data collection rules consistently to maintain compliance with state, federal, and payer requirements
Use coding and validation tools such as Epic, 3M applications, encoders, audit platforms, and standard office software to verify information and complete assigned work
Maintain productivity and quality benchmarks while working independently, organizing priorities effectively, and resolving issues that affect coding accuracy or timeliness

What we offer

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

Claims Review Specialist

We're seeking a detail-oriented professional who can support the coordination an...

Location

United States , Tempe

Salary:

20.00 - 30.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

High school diploma or general education degree (GED) required
Minimum 3 years related experience and/or training, or equivalent combination of education and experience
Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses relative to Stop Loss preferred
Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
Computer literacy with proficiency in Windows and Microsoft Office environment (Word, Excel, Outlook)
Knowledge of insurance database systems preferred
Experience with EDOCS platform or similar documentation management systems
Detail-oriented, analytical, financially minded approach to Stop Loss coordination
Ability to read, analyze, and interpret common financial reports and legal documents
Capability to work with mathematical concepts such as probability and statistical inference

Job Responsibility

Prepare Stop Loss submissions: Analyze Stop Loss claims and applicable documents to determine filing eligibility under Excess Loss Policy while processing all submissions within established timeframes
Coordinate funding requests: Manage Advanced Funding Requests with clients and Stop Loss carriers while maintaining comprehensive database of all specific reimbursement requests
Manage documentation systems: Create initial Specific File for each claimant and file all submissions in EDOCS platform while coordinating release of Over Specific, System Hold claims
Serve as liaison: Act as connection point between PBMs and internal clients for Stop Loss claimants while maintaining professional communication with all stakeholders
Monitor reimbursements: Track all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reimbursement reports and following up with carriers
Support plan year activities: Assist with Plan Year End Closeouts while keeping immediate supervisor apprised of open or disputed items requiring attention
Maintain workflow excellence: Contribute to daily workflow with regular, punctual attendance while performing related or assigned duties as required

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Unlimited PTO
Mental health support
Retirement planning
Financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture

Fulltime

Senior Field Reimbursement Specialist

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specia...

Location

United States , Remote

Salary:

100700.00 - 155100.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

Experience related and progressively responsible in a medical practice, private or third-party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support
Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred
Bachelor’s degree preferred
Minimum of 7 years of experience
Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment
Ability to effectively manage multiple client relationships and customer
Ability to manage and support external meetings, presentations, and client interactions
Ability to lead and work in a matrix environment
Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations
Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

Job Responsibility

Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product
Track progress and evaluate results of assigned activities
Recommends changes in procedures
Lead or direct more complex projects or certain aspects of projects
Operates with reasonable latitude for un-reviewed action or decision
Work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings
Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients
Review patient insurance benefit options with appropriate authorizations
Validate prior authorization requirements
Understanding of Specialty Pharmacy processes

What we offer

medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families
backup dependent care
adoption assistance
infertility coverage
family building support
behavioral health solutions

Fulltime

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Medical Coding Reimbursement Review Specialist

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