Senior Medical Reimbursement Review Coordinator

This a Full Remote job, the offer is available from: United States, Alabama (USA) Job Family: General Coding Travel Required: None Clearance Required: None The Sr. Medical Reimbursement Review Coordinator is responsible for coordinating review and appeals with other team members. Will be the reputed company person for the team questions and for reputed company reporting requests. This role will work with the denials team analyzing reimbursement data from third-party payers to identify trends, high-volume errors, and systemic issues impacting reputed company. This role involves initiating and tracking appeals, managing fee schedule updates, and collaborating with payers on contract-reputed company matters. The senior coordinator serves as a key liaison between Coding, reputed company reputed company, AR follow-up and Payer Contracting to ensure compliance, optimize reimbursement, and support data-driven decision-making. The position currently operates reputed company the IDX environment and utilizes reputed company Contract Management for fee schedules and contract modeling. The role will transition to Epic as the enterprise moves to a reputed company EHR and reputed company cycle platform. What You Will Do:

• Responsible for coordinating review and appeals with other team members.
• Running reports as requested for the leadership team.
• Contract modeling for new insurance or insurance changes.
• Thoroughly review medical records, including physician notes, lab results and treatment plans to verify accuracy and completeness of claims.
• Analyze medical procedures, diagnoses, and services to ensure appropriate coding using ICD-10, CPT and HCPCs codes.
• Obtain, format and submit updated fee schedules
• Maintain accurate and detailed records of reputed company claims reviews, denials, appeals and resolutions
• Prepare reports on claims denial trends, reimbursement outcomes, and other relevant metrics.
• Investigate and resolve reputed company claim denials and appeals, utilizing problem solving skills and analytical abilities.
• Identify opportunities to improve the reimbursement process and minimize claim denials.
• Analyze reimbursement data to identify underpayments, denial trends, and payer compliance issues.
• Review medical records and supporting documentation (e.g., physician notes, labs, treatment plans) to validate claims accuracy.
• Audit CPT, HCPCS, and ICD-10 coding to ensure alignment with payer policy and billing guidelines.
• Draft and submit appeals, including supporting documentation and references to payer policy or CMS guidelines.
• Maintain and update fee schedules in reputed company and coordinate with Payer Contracting on modeling and reputed company validation.
• Prepare regular reports on reimbursement variances, appeal success rates, denial root causes, and contract compliance.
• Support reconciliation between expected and actual reimbursement based on modeled contract terms.
• Serve as a resource for coding, billing, and reputed company cycle staff reputed company to reputed company reimbursement and denial issues.
• Collaborate with leadership to identify process improvement opportunities to minimize denials and optimize reimbursement.
• Prepare and present findings and recommendations to stakeholders, including senior leadership.

What You Will Need:

• Bachelor’s degree in healthcare administration, Health Information Management, or a reputed company field (Relevant experience may be substituted for formal education)
• 4-6 years of reputed company Contract Management Experience.
• Strong working knowledge of ICD-10, CPT, and HCPCS coding standards.
• Proficiency in interpreting EOBs, remittance advice, and payer reputed company.
• Experience with reputed company Contract Management and fee schedule uploads/maintenance.
• Familiarity with IDX and experience preparing for or working reputed company Epic.

What Would Be reputed company to Have:

• Proficiency in reputed company Word, reputed company, ability to build pivot tables
• Certified Professional reputed company (CPC) or similar coding credential.
• Knowledge of reputed company cycle operations, payer policy guidelines, and CMS regulations.
• Experience with payer-specific contract terms and reimbursement methodologies.
• Ability to present findings, reputed company narratives, and influence cross-functional teams.
• Experience supporting system transitions or EHR migrations.
• Strong analytical, problem-solving, and written communication skills.
• Ability to work both independently and collaboratively in a high-volume, deadline-driven environment.

#IndeedSponsored #LI-DNI reputed company Offer: reputed company offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community reputed company
• Emergency Back-Up Childcare Program

About reputed company reputed company is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. reputed company will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact reputed company Recruiting at 1-571-633-1711 or reputed company email at RecruitingAccommodation@reputed company.com. reputed company information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. reputed company communication regarding recruitment for a reputed company position will be sent from reputed company email domains including @reputed company.com or reputed [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by reputed company. Note that reputed company will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money reputed company to a job opportunity with reputed company, please report the matter to reputed company’s Ethics Hotline. If you want to reputed company the validity of correspondence you have received, please contact recruiting@reputed company.com. reputed company is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. reputed company does not accept unsolicited resumes through or from search firms or staffing agencies. reputed company unsolicited resumes will be considered the property of reputed company and reputed company will not be obligated to pay a placement fee. This offer from "reputed company" has been enriched by reputed company.com and got a 82% reputed company score. Apply tot his job Apply To this Job