Medical Coding Reimbursement Review Spec

 Medical Coding Reimbursement Review Specialist

 Pay: $21.42 per hour
 Schedule: Monday through Friday, 9:00 AM to 5:30 PM
 Location: Remote
 Assignment Type: Temp-to-Perm
 Equipment Provided: Yes, equipment provided by client

We are seeking an experienced and detail-oriented Medical Coding Reimbursement Review Specialist to support retrospective payment reimbursement reviews in a fast-paced, deadline-driven environment. This role is ideal for candidates with strong inpatient coding experience, deep CPT coding expertise, and a strong understanding of modifiers, reimbursement methodologies, and Independent Dispute Resolution Entity (IDRE) processes.

The ideal candidate will have 3-5 years of coding experience, strong retrospective review capabilities, and the ability to clearly explain the IDR process during interviews.

Key Responsibilities

• Perform retrospective payment reimbursement reviews with a strong focus on inpatient coding
• Analyze CPT codes, modifiers, and claim interactions to ensure accurate reimbursement determinations
• Review and interpret Explanations of Benefits (EOBs), including recoupments, corrections, denials, and claim adjustments
• Evaluate how CPT modifiers impact reimbursement and payment outcomes
• Conduct coding reviews across multiple provider specialties with broad CPT code knowledge
• Review medical claims for compliance with coding standards and reimbursement guidelines
• Prepare clear, accurate, and final binding payment determination letters for clients and disputing parties
• Support Independent Dispute Resolution (IDR) cases and demonstrate knowledge of the full IDR process
• Maintain compliance with billing regulations, coding standards, and applicable healthcare laws
• Manage multiple priorities effectively while meeting strict deadlines in a high-volume environment

Required Qualifications

• Certified Medical Coder certification required through recognized organizations such as:
  • AAPC (American Academy of Professional Coders)
  • AHIMA (American Health Information Management Association)
• Preferred certifications include:
  • CPC (Certified Professional Coder)
  • CCS (Certified Coding Specialist)
• Strong inpatient coding experience required
• 3-5 years of medical coding and reimbursement review experience preferred
• Experience with CPT codes, ICD-10-CM, and HCPCS coding systems required
• Strong understanding of CPT modifiers and reimbursement impact required
• Experience with retrospective coding reviews required
• IDRE experience required
• Must be able to explain the IDR process during the interview
• Strong understanding of EOB review and claims adjustment analysis
• Knowledge of the No Surprises Act and its billing implications preferred
• Excellent written communication skills required for formal payment determination documentation
• High School Diploma or GED required
• Associate degree from an accredited college or university preferred

Ideal Candidate Profile

The ideal candidate is highly analytical, deadline-driven, and exceptionally detail-oriented. They understand the financial and compliance impact of coding accuracy and can confidently navigate complex reimbursement disputes while maintaining professionalism, accuracy, and regulatory compliance.

Throughout the past 35+ years, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.
 
 We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.
 
 MMC is a privately owned business with corporate headquarters in Irving, Texas. With 2,000+ employees, working in 40+ states, MMC is able to support all United States locations, and some international locations.
 
 We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at www.mmcgrp.com 
 
 Benefits with MMC Group
 MMC offers health insurance plans for our active candidates on assignment, including:

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

  Join MMC and enjoy the support of a team that values your well-being, both on and off the job!
 
 MMC strives to ensure all job postings confirm details of the position, the rate of pay, and acknowledge that medical benefits are offered.
 
 Get started on your career journey today! Apply to become a part of the MMC Team!
 
 We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.