Rocky Mountain Review brings clarity and confidence to healthcare by focusing on what matters most—accuracy, accountability, and the people behind every claim.
In an industry often driven by speed and volume, Rocky Mountain Review stands for thoughtful review and sound judgment. Our approach is rooted in a simple belief: every decision should be defensible, every outcome intentional, and every client supported with consistency they can rely on.
We engage deeply across the claim lifecycle—strengthening payment integrity, supporting plan performance, and delivering insights that empower better decisions. By combining clinical expertise with meticulous review processes, we ensure that nothing is overlooked, and everything is aligned, every time.
About This Opportunity:
As a Lead Coding, Audit, and Compliance Specialist, you play a critical role in ensuring accuracy and integrity across the claims process. From initial review to detailed analysis, you uncover inconsistencies, identify improper billing practices, and validate coding against established guidelines and industry standards.
Your work goes beyond detection—you translate findings into meaningful insights that drive informed decisions. By highlighting cost-saving opportunities and sharing clear, actionable recommendations with internal teams and leadership, you help strengthen outcomes for clients and reinforce confidence in every claim reviewed.
This role requires a balance of analytical precision and practical judgment, supported by strong communication skills, disciplined organization, and a commitment to getting the details right every time.
Things You’ll Do Here:
Review medical bills to identify appropriate billing, coding, and savings opportunities.
Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review.
Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings.
Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries.
Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis.
Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies.
Provide guidance and mentor junior analysts in claim review best practices.
Assist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development.
Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures.
Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction.
Ensure compliance with HIPAA and other regulatory standards.
Perform other duties as assigned.
Reasonable accommodation may be provided to enable individuals with disabilities to perform essential duties.
What You’ll Bring to the Team:
2+ years of auditing, claims, review and/or billing experience within a healthcare organization.
CPC, CIC or CPMA/CPCO preferred
Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc.
Experience with complex claims (inpatient preferred)
Excellent communication skills, both verbal and written
Knowledge of CMS guidelines
A plus if you have:
Experience in DRG validation.
Knowledge of Health Insurance, Medicare guidelines, and various healthcare programs.
Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!
Work Environment: You’ll need a quiet workspace that is free from distractions.
Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.
Why You'll Love Working Here
Rocky Mountain Review is proud our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.
Benefits
Generously subsidized company-sponsored Medical Insurance
Spending account options: HRA, FLEX
401K with company match
Flexible working environment
Generous Paid Time Off to include vacation, sick leave, and paid holidays
• Real conversations and direct collaboration
• Leadership that values critical thinking
Required certifications: CIC, and CIC-CPC dual credentialed individuals
This position will be Remote.
• Opportunity to make a visible impact on high-dollar claims
If you enjoy solving the puzzle behind the claim—not just processing volume—we’d love to connect.
Reply to HR@rm-review.com with your resume and we’ll take it from there.
At RMR we understand that our Clients have specific needs. Let’s talk. Now more than ever, it is necessary to stay on top of the changes weaving their way into our industry. In turn, it is our belief that Cost Containment efforts must also evolve to maintain relevance and effectiveness. RMR’s products strive to be dynamic. This ensures both product compliance and relevant results are delivered.