[Hiring] Medical Coding Reimbursement Review Specialist @MMC Group

Role Description

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.

• 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

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

Benefits

• 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!