Medical Coding Specialist - IDR ReviewsLocation: Remote
Schedule: Monday - Friday | 9:00 AM - 5:30 PM
Pay Rate: $21.42/hour
Type: Contract-to-Hire
We are seeking an experienced Inpatient Medical Coding Specialist to support retrospective payment reimbursement reviews in a fast-paced, deadline-driven environment. This role requires a strong background in inpatient coding, including extensive experience with CPT codes, modifiers, reimbursement methodologies, and retrospective coding reviews.
The ideal candidate will have 2-4 years of coding experience, strong analytical skills, and prior IDRE experience. Candidates must be able to clearly explain the IDR process during the interview.
Key Responsibilities - Perform retrospective inpatient coding and reimbursement reviews
- Review and analyze CPT, ICD-10-CM, and HCPCS coding for accuracy and compliance
- Evaluate CPT modifiers and their impact on reimbursement outcomes
- Interpret Explanations of Benefits (EOBs), including recoupments, corrections, denials, and claim adjustments
- Conduct detailed reviews across multiple provider specialties with a focus on inpatient services
- Draft final and binding payment determination letters for clients and disputing parties
- Ensure compliance with coding regulations, reimbursement guidelines, and billing standards
Required Qualifications - 2-4 years of inpatient medical coding experience preferred
- Strong experience with retrospective coding reviews
- Prior IDRE experience required
- Must be able to explain the IDR process during the interview
- CPC or CCS certification required through AAPC or AHIMA
- Advanced knowledge of:
- CPT codes
- ICD-10-CM
- HCPCS
- CPT modifiers and reimbursement methodologies
- Strong understanding of inpatient coding guidelines and claim review processes
- Excellent written communication skills and attention to detail