We are seeking an experienced Inpatient Medical Coding Specialist to support retrospective payment reimbursement reviews in a fast-paced, deadline-driven environment. This role requires a strong background in inpatient coding, including extensive experience with CPT codes, modifiers, reimbursement methodologies, and retrospective coding reviews.
The ideal candidate will have 2–4 years of coding experience, strong analytical skills, and prior IDRE experience. Candidates must be able to clearly explain the IDR process during the interview.
Key Responsibilities
Perform retrospective inpatient coding and reimbursement reviews
Review and analyze CPT, ICD-10-CM, and HCPCS coding for accuracy and compliance
Evaluate CPT modifiers and their impact on reimbursement outcomes
Interpret Explanations of Benefits (EOBs), including recoupments, corrections, denials, and claim adjustments
Conduct detailed reviews across multiple provider specialties with a focus on inpatient services
Draft final and binding payment determination letters for clients and disputing parties
Ensure compliance with coding regulations, reimbursement guidelines, and billing standards
Required Qualifications
2–4 years of inpatient medical coding experience preferred
Strong experience with retrospective coding reviews
Prior IDRE experience required
Must be able to explain the IDR process during the interview
CPC or CCS certification required through AAPC or AHIMA
Advanced knowledge of:
CPT codes
ICD-10-CM
HCPCS
CPT modifiers and reimbursement methodologies
Strong understanding of inpatient coding guidelines and claim review processes
Excellent written communication skills and attention to detail