Medical Coder

TEKsystems • Berwyn, IL

5d • $25 - $25 • Remote

About The Position

Join a growing healthcare review organization that partners with government agencies, third-party administrators, insurance carriers, and self-funded employers to provide independent medical review services. Due to increased volume related to the No Surprises Act and ongoing case backlog projects, the organization is expanding its team to support claim payment determination reviews. This role is suited to individuals with an active CPC or CPC-A certification who want to build healthcare coding and reimbursement knowledge in an analytical position. Although coding knowledge is required, the work focuses on claim review and payment determinations rather than performing medical coding.

Requirements

• Active CPC or CPC-A certification.
• Understanding of CPT codes and insurance reimbursement methodologies.
• Strong analytical, decision-making, and problem-solving skills.
• Ability to work independently in a fast-paced, production-driven environment.
• Comfort learning new processes within a growing department.

Nice To Haves

• Experience working with EOBs (Explanation of Benefits) and appeals processing.
• Healthcare billing, medical coding, claims, or reimbursement experience.
• Experience with emergency services, ambulance, or facility/professional billing.
• Knowledge of the No Surprises Act (NSA).

Responsibilities

• Review medical claims and supporting documentation to determine appropriate payment outcomes.
• Analyze claim information, CPT codes, EOBs, and reimbursement data to support payment determinations.
• Validate and verify claim data for accuracy and completeness.
• Review disputes involving emergency services, ambulance services, air ambulance, and other healthcare claims.
• Document the rationale for payment decisions in accordance with established guidelines and regulations.
• Use internal claims management systems to process and review case files.
• Maintain productivity and quality standards while handling a high volume of cases.
• Collaborate with internal teams to ensure accurate and timely claim resolutions.

Benefits

• Medical, dental, and vision benefits, if eligible.
• Critical illness, accident, and hospital coverage, if eligible.
• 401(k) retirement plan with pre-tax and Roth post-tax contributions available, if eligible.
• Voluntary life and AD&D insurance for the employee and dependents, if eligible.
• Short- and long-term disability, if eligible.
• Health Spending Account (HSA), if eligible.
• Transportation benefits, if eligible.
• Employee Assistance Program, if eligible.
• Time off/leave, including PTO, vacation, or sick leave, if eligible.

What This Job Offers

• Career Level: Entry Level
• Education Level: No Education Listed