Description & Requirements

Are you a detail-oriented professional with deep expertise in healthcare billing and coding-and exceptional communication skills to match?

Maximus is seeking a Senior Medical Billing and Coding Coordinator to support our California Independent Medical Review (IMR) project-all from the comfort of your home. This fully remote position offers flexibility while enabling you to take ownership of complex case reviews and contribute to healthcare integrity.

This position is ideal for professionals who thrive in remote settings, value autonomy, and bring sharp analytical skills to regulatory decision-making.

Why Maximus?

Work/Life Balance Support - Flexibility tailored to your needs! • Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. • Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. • Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short- and Long-Term Disability coverage. • Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). • Recognition Platform - Acknowledge and appreciate outstanding employee contributions. • Tuition Reimbursement - Invest in your ongoing education and development. • Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. • Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs. • Professional Development Opportunities-Participate in training programs, workshops, and conferences. •Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees

Essential Duties and Responsibilities: - Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data. - Enter coded data into a system accurately and validate date entered. - Research correct coding practices, clearly document and share findings with others. - Write clear and concise rationales that provide defensible support of decisions. - Train staff members on the coding processes (both project specific and general coding). - Perform QA audits on coding process. - Recommend and suggest improvements to assigned projects. - Perform other duties as assigned by management.

- Apply California Workers' Compensation regulations and calculate fee schedule allowances. - Evaluate the accuracy and appropriateness of coded and billed medical information - Develop final determination letters based on regulatory and clinical standards - Abstract key data from complex case files and medical records - Assign and verify CPT, HCPCS, and ICD-10-CM codes using industry-standard billing guidelines - Apply specialized regulations including California Workers' Compensation, CMS policies, AMA CPT coding guidelines, and CA fee schedules - Collaborate virtually with cross-functional teams to drive quality and compliance

Minimum Requirements

- High school diploma or equivalent with 4+ years of experience, or AA with 2+ years of experience.

- Preferred risk adjustment auditing experience of coding inpatient and outpatient medical records. - CPC, CCS, or RHIT Certification required. - Ability to use critical thinking skills. - Must have excellent writing skills.

- Experience coding physician, inpatient and/or outpatient medical records required.

- Strong computer skills, including Word, Excel, and Outlook.

- Mathematical skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Preferred Requirements - Bachelor's degree from an accredited institution - Experience as a medical claim examiner, reviewing physician and hospital PPO contracts - Experience with California Workers' Compensation Official Medical Fee Schedule - Experience with CMS payment methodologies: IPPS, OPPS, DMEPOS and Physician Fee Schedule

Home Office Requirements - Maximus provides company-issued computer equipment - Reliable high-speed internet service * Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity * Minimum 5 Mpbs upload speeds

#NYMC #LI-Remote

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.

Minimum Salary

$

28.03

Maximum Salary

$

37.40

*