[Hiring] Medical Reviewer, Coder @J29

Role Description

This is a temporary seasonal position. Employment is anticipated to continue for up to six months based on business needs.

Medical Reviewer, Coder

Location: Remote

Rate: $35-40 hourly

Key Responsibilities

• Perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims, including Part A/B, DMEPOS, and Home Health/Hospice.
• Assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs).
• Apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules.
• Document clear, accurate findings for each claim.
• Participate in dispute resolution by re-examining claims and providing supporting documentation.
• Support quality assurance through audits and ongoing training.
• Maintain compliance with CMS security and privacy standards.
• Collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities.

Qualifications

• 5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment.
• 3+ years working in a productivity-based claims or case working environment, out of a queued case management system.
• 3+ years working remotely with various technology systems.
• 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program is ideal.
• Experience with low-code, no-code case management systems as an end-user is preferred but not required.

Requirements

• Certified from an accredited association such as the American Association of Professional Coders (AAPC) or American Health Information Management Association (AHIMA).
• May also be Registered Health Information Administrators (RHIA) and Registered Health Information Technicians (RHIT); credentialed by AHIMA in their field of health information.