Medical Coder

Job Title:Medical Coding Review Specialist IDR / IDRE
Location: Remote
Schedule: Monday through Friday 9:00 AM to 5:30 PM
Pay Rate:$21.42 per hour
Employment Type: Term to Perm
Equipment: Client provided

Position Overview

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

Required Qualifications

• Certified Medical Codercredential from a recognized organization such as:
  • AAPC
  • AHIMA
  • CPC
  • 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
  • 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
  • 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.

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 2000 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

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 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.