Team prefers to see candidates with 3 -5 years of experience. Additional Information:
Location: Remote
Type: Term to Perm
Hours: 8:30a - 5p Mon - Fri EST
We are seeking a highly motivated, detail-oriented, and adaptable professional to join our team and perform retrospective payment reimbursement reviews. The ideal candidate is a fast learner who can hit the ground running, thrives in a fast-paced, deadline-driven environment, and can effectively manage multiple priorities with accuracy and efficiency. The successful candidate will possess strong analytical and critical thinking skills, enabling them to evaluate complex reimbursement scenarios, identify payment discrepancies, interpret payer denials, and make well-supported payment determinations.
This individual must have a
strong understanding of how modifiers impact reimbursement and how CPT codes interact with one another. The candidate should also be proficient in
reading and interpreting Explanations of Benefits (EOBs), including recoupments, corrections, and other claim adjustments. Additionally, a broad and in depth knowledge of CPT codes across all provider specialties is essential.
- Certified Medical Coder- certification from recognized organizations such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Knowledge of Medical Billing and Coding Systems: Familiarity with coding systems such as ICD-10-CM, CPT, and HCPCS is essential as well as experience with CPT modifiers and how they impact reimbursement.
- Revenue Cycle Management (RCM) Expertise Strong knowledge of healthcare revenue cycle processes, including charge capture, claims submission, reimbursement methodologies, payment posting, denial management, appeals, underpayment identification, contract compliance, and accounts receivable management. Experience analyzing reimbursement trends and identifying opportunities for revenue recovery is highly preferred.
- Attention to Detail: Accuracy is critical in the medical coding review to ensure correct billing and compliance with regulations. Attention to detail helps in avoiding errors that could lead to billing disputes or legal issues.
- Understanding of the No Surprises Act: An understanding of the No Surprises Act and its implications for billing practices is preferred.
- Excellent writing skills: The coder will be responsible for writing final and binding payment determination letters that will be distributed to our client as well as the disputing parties.
- Reimbursement Review and EOB Analysis Experience Demonstrated ability to interpret Explanations of Benefits (EOBs), identify payment discrepancies, evaluate recoupments and adjustments, and determine appropriate reimbursement based on coding guidelines, payer policies, and contractual requirements.
- Critical Thinking and Analytical Skills Demonstrated ability to analyze complex coding, billing, and reimbursement scenarios; evaluate supporting documentation; interpret regulatory and payer guidelines; and make sound, defensible decisions. The ideal candidate can identify patterns, investigate discrepancies, synthesize information from multiple sources, and provide logical, well-reasoned, unbiased payment determinations.
Education Requirement:
" High School Diploma or GED is required. An Associate s degree from an accredited college or university is preferred