Medical Coder

TEKsystems•Indianapolis, IN

2d•$25 - $25•Remote

About The Position

We are seeking a Medical Claims & Billing Review Specialist to join a growing healthcare claims review team. This position is ideal for someone with experience in medical billing, claims, denials/appeals, and EOB review who holds an active CPC or CPC-A certification and is looking to expand their healthcare reimbursement knowledge. In this role, you will review healthcare claims and billing information to assist with payment determinations and dispute resolution. While an understanding of CPT codes and insurance guidelines is important, this is not a traditional coding position and you will not be responsible for coding charts.

Requirements

Active CPC or CPC-A certification required.
Experience with medical billing, healthcare claims, denials, appeals, and EOBs strongly preferred.
Working knowledge of CPT codes, medical billing practices, and insurance guidelines.
Experience on either the professional or facility billing side is welcome.
Strong attention to detail and ability to review and validate high volumes of claims information.
Ability to work independently in a remote environment and adapt to a growing team and evolving processes.

Nice To Haves

Experience with emergency services, ambulance, air ambulance, or other emergency provider billing is helpful, but not required.
Knowledge of the No Surprises Act (NSA) or Independent Dispute Resolution process is a plus, but not required.

Responsibilities

Review medical claims, billing information, EOBs, denials, and appeals to support accurate payment determinations.
Analyze claim details, CPT codes, reimbursement information, and supporting documentation to determine appropriate payment outcomes.
Validate and verify claims data for accuracy and completeness before making determinations.
Review disputed claims in which parties have been unable to agree on appropriate reimbursement.
Apply knowledge of medical billing, insurance parameters, claims processing, denials, and appeals when reviewing cases.
Document claim determinations and supporting rationale within an internal claims management system.
Review claims involving professional or facility services, including emergency and ambulance services.
Adapt to changing processes and procedures as part of a newly developed and growing team.