Role Description

We are seeking a highly motivated, detail-oriented Medical Coding Review Specialist to support retrospective payment reimbursement reviews in a fast-paced, deadline-driven environment. This role is ideal for a coding professional with strong inpatient coding experience, deep knowledge of CPT codes, modifiers, and reimbursement impacts, and hands-on exposure to the Independent Dispute Resolution Entity, IDRE, process.

The ideal candidate will be able to manage multiple priorities with accuracy, interpret complex claim activity, and produce clear, professional written determinations. Candidates should have 3 to 5 years of relevant experience.

Key Responsibilities

• 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.

Qualifications

• Certified Medical Coder credential from a recognized organization such as AAPC, AHIMA, CPC, or 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, and 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, and 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.

Preferred Qualifications

• Understanding of the No Surprises Act and its impact on billing and reimbursement practices.
• Associate degree from an accredited college or university.

Education

• High School Diploma or GED required.
• Associate degree preferred.

Ideal Candidate Profile

The strongest candidates will bring a solid blend of inpatient coding expertise, reimbursement review experience, modifier knowledge, and IDRE exposure. They will be comfortable working independently in a remote setting, managing competing deadlines, and producing high-quality written determinations in a regulated environment.

Benefits

• 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!