Medical Coder Arbitration
Description & Requirements Maximus is currently hiring for a Medical Coder to join our NY State Arbitration team. This is a remote opportunity. The Medical Coder is responsible for completing retrospective reimbursement reviews which includes reviewing services rendered and determining a reasonable reimbursement. They will be responsible for writing final and binding payment determination letters that will be distributed to our client as well as the disputing parties. Accuracy is critical in the medical coding review to ensure correct billing and compliance with regulations. The ideal candidate thrives in a fast‑paced, deadline‑driven environment and can effectively manage multiple priorities with accuracy and efficiency. Essential Duties and Responsibilities: - Abstract and code clinical data. - Audit medical records to ensure compliance with the organization's coding procedures and standards. - Accurately enter coded data in a system and validate data entered. - Research correct coding practices, clearly document and share findings with others. - Review denials and recommend billing corrections. - Train staff members on the coding process. Minimum Requirements - High School diploma or equivalent with 0 - 2 years of experience. - Additional clinical licensure may be required based on project. - Must be a Certified Medical Coder, Certified Professional Coder, or a Certified Coding Specialist. - Knowledge of Medical Billing and Coding Systems such as CPT and HCPCS is essential. - Ability to work a schedule between the hours of 8:00am - 5:00pm EST Monday - Friday required. Additional Skills and Experience: - Familiarity with retrospective payment reimbursement highly preferred. - Experience with CPT modifiers and how they impact reimbursement preferred. - Understanding of the No Surprises Act and its implications for billing practices preferred. - Proficiency in reading and interpreting Explanations of Benefits (EOBs), including recoupments, corrections, and other claim adjustments highly preferred. Please note: This position requires the use of your personal device for the duration of training. After training, equipment will be provided. Home Office Requirements: - Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net) - Minimum 5mpbs upload speed - Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router - Personal computer or laptop (Chromebooks, tablets, and notebooks are not allowed) with one of the following operating systems: Windows: 10 or 11 or Mac: Big Sur (11.0.1+), Catalina (10.15), or Monterey (12.3) - Private and secure work area and adequate power source - Must currently and permanently reside in the Continental US - Must have a smartphone which will be required to log into Maximus systems EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at [email protected] . Minimum Salary $20.00 Maximum Salary $22.00 Compensation: $20-$22 Remote: Yes Apply tot his job Apply To this Job