Coding and Reimbursement Specialist

Coding And Reimbursement Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Coding and Reimbursement Specialist based in United States. This remote role is an opportunity to serve as a subject matter expert in healthcare provider billing, coding, and reimbursement. You'll respond to post-payment inquiries, support accurate claim processing, and help resolve coding and reimbursement issues. The position combines claims auditing, regulatory expertise, provider education, and process improvement. You'll work closely with physicians, practice managers, billing teams, credentialing teams, and internal leadership. Your expertise will help strengthen payment accuracy while identifying opportunities to reduce fraud, waste, and abuse. This is a collaborative environment where clear communication and up-to-date knowledge of Medicare requirements are essential.

Accountabilities:

As a Coding and Reimbursement Specialist, you will provide expert guidance on provider billing, coding, documentation, and reimbursement while supporting accurate and compliant claims operations.

• Review and respond to post-payment inquiries from providers regarding claim disposition and reimbursement.
• Process pended claims and release claims held for coding-related issues to help ensure accurate payments to providers and members.
• Review member reimbursement requests and help resolve related issues.
• Collaborate with provider credentialing teams to ensure appropriate setup for accurate claim payments.
• Conduct audits and analyze internal reporting to identify trends, risks, and opportunities for improvement.
• Develop and present reports and findings to health plan leadership.
• Build and maintain effective working relationships with providers and their billing teams.
• Support claims auditing activities as workload and business needs require.
• Develop educational tools, presentations, and resources covering documentation, coding, billing, and other relevant topics for the provider community.
• Analyze claims processes to identify potential fraud, waste, and abuse and recommend improvements.
• Participate in coding and billing conferences, workshops, and internal education sessions to remain current with industry regulations and requirements.

Requirements:

• High school diploma required; bachelor's degree preferred.
• At least 5 years of experience in claims auditing, medical billing, and/or coding.
• CPC, CPC-P, or equivalent coding certification preferred.
• In-depth knowledge of current Medicare coding and billing requirements.
• Strong understanding of multi-specialty coding and billing requirements.
• Extensive knowledge of auditing concepts and principles.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced knowledge of ICD-10, CPT-4, and HCPCS coding principles and documentation guidelines.
• Extensive understanding of Medicare regulations and policies related to documentation, coding, and billing.
• Strong written and verbal communication skills, with the ability to explain complex regulatory and coding information in clear, accessible terms.
• Ability to communicate effectively with physicians, practice managers, billing managers, billing staff, internal teams, and other stakeholders.
• Strong analytical, problem-solving, organizational, and relationship-building skills.
• Ability to work independently in a remote environment while collaborating effectively with cross-functional teams.

Benefits:

• Competitive compensation and benefits package.
• Medical, dental, and vision coverage starting on day one.
• Retirement savings plan with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition and professional development reimbursement.
• Relocation assistance, subject to geographic and position restrictions.
• Discounted tuition and enrollment opportunities at a nursing college.
• Employee referral rewards program.
• DailyPay access for eligible employees, allowing earned wages to be accessed before payday.
• Opportunities to participate in Diversity, Equity, and Inclusion colleague resource groups.