[Hiring] Medical Coder Coordinator @Integrated Resources

Role Description

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.

• Possess strong analytical and critical thinking skills.
• Evaluate complex reimbursement scenarios.
• Identify payment discrepancies and interpret payer denials.
• Make well-supported payment determinations.
• Strong understanding of how modifiers impact reimbursement and how CPT codes interact with one another.
• Proficient in reading and interpreting Explanations of Benefits (EOBs), including recoupments, corrections, and other claim adjustments.
• Broad and in-depth knowledge of CPT codes across all provider specialties.

Qualifications

• 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, including familiarity with coding systems such as ICD-10-CM, CPT, and HCPCS.
• Experience with CPT modifiers and how they impact reimbursement.

Requirements

• 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 to ensure correct billing and compliance with regulations.
• Understanding of the No Surprises Act and its implications for billing practices is preferred.
• Excellent writing skills for writing final and binding payment determination letters.
• 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 to analyze complex coding, billing, and reimbursement scenarios.
• Ability to 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.