We are seeking a Senior Medical Coding & Reimbursement Specialist to support federal health programs by providing expertise in healthcare coding, reimbursement, provider billing practices, and claims operations.
In this role, you will help shape how coding standards, reimbursement requirements, provider billing workflows, and healthcare service relationships are analyzed, evaluated, and operationalized across clinical, operational, reimbursement, and analytics stakeholders.
You will apply knowledge of CPT, HCPCS, ICD-10, modifiers, revenue codes, claims adjudication, and reimbursement methodologies to support consistent decision-making, improve operational understanding, and ensure healthcare services are accurately represented within program processes and supporting frameworks.
Responsibilities
- Develop, refine, and maintain CPT, HCPCS, ICD-10, modifier, revenue code, and ancillary service code groupings
- Support development of code sets that accurately represent episodes of care, treatment pathways, and healthcare services
- Research coding guidance, Medicare policies, reimbursement methodologies, and billing requirements to support code inclusion and exclusion decisions
- Identify related, supporting, bundled, ancillary, add-on, and downstream services associated with diagnoses and procedures
- Validate code sets against Medicare requirements, fee schedules, reimbursement policies, NCCI edits, and coding standards
- Review provider billing practices and claims patterns to identify missing, duplicative, or inappropriate code relationships
- Document coding rationale, business rules, assumptions, exclusions, and validation findings
- Participate in coding reviews, clinical reviews, quality control activities, and stakeholder reviews
- Collaborate with clinicians, reimbursement SMEs, and analytics teams to evaluate code inclusion, exclusion, and grouping decisions
- Support governance processes, change requests, maintenance activities, and version control efforts
Qualifications
- 5+ years of experience in medical coding, reimbursement, payment integrity, auditing, compliance, revenue cycle, or claims operations
- Strong knowledge of CPT, HCPCS, ICD-10-CM, ICD-10-PCS, revenue codes, modifiers, Medicare reimbursement methodologies, claims adjudication, provider billing workflows, NCCI edits, and fee schedules
- Experience working within payer, provider, TPA, Medicare, Medicaid, TRICARE, Commercial, or Federal healthcare environments
- Ability to translate coding guidance and reimbursement requirements into operationally actionable code set recommendations
- One or more of the following certifications preferred: CPC, COC, CPMA, CRC, RHIA, RHIT, CHC, CEDC, COBGC, COSC
Benefits
- Competitive compensation
- Flexible benefits package
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Discretionary variable incentive bonus eligibility
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
Location
Washington, District of Columbia, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
1 week ago