Remote Coding & Cost Analyst (CPC/CCS)

Geisinger; United States; Remote; USD 55,000 - 85,000; Full time

Benefits offered by this job

Work-from-home option

HIPAA privacy compliance

Job summary

Geisinger is seeking a skilled Medical Coder to review and advise on coding, billing, and reimbursement across Claims, Edits, Appeals, and Grievances. The role supports inpatient and outpatient high-dollar claims and collaborates with Pharmacy and PNM teams.

The candidate will validate payments according to contracts, participate in workgroups, and assist with onboarding. A CPC/CCS certification is required, with LPN preferred, and remote work options are available.

Qualifications

• Proven CPT/CMS guideline knowledge is required.
• Experience reviewing Claims, Edits, Appeals, and Grievances is essential.
• Proficiency with HIPAA privacy practices is expected.

Responsibilities

• Provide review and recommendations for correct coding, billing, and reimbursement.
• Complete clinical reviews for Claims, Claim Edits, Appeals, and Grievance processes.
• Recommend recovery efforts based on contracts, policies, procedures and industry standards.
• Review and validate pended/reconsidered claims with plan editing software (vendors).
• Complete reviews on inpatient and outpatient high-dollar claims and assist with quality concerns.
• Validate claim payments in line with Plan contracts and collaborate with Pharmacy and PNM teams.
• Create and maintain various department reports.
• Assist in onboarding new team members and participate in ad hoc workgroups or committees.
• Attend occasional onsite department meetings as needed.

Skills

Medical coding review

Billing compliance

Claims analysis

Education

CPC-Certified Professional Coder (AAPC)

CCS-Certified Coding Specialist (AHIMA)

LPN preferred

Tools

Plan claim editing software

Job description

Geisinger is seeking a skilled Medical Coder to review and advise on coding, billing, and reimbursement across Claims, Edits, Appeals, and Grievances. The role supports inpatient and outpatient high-dollar claims and collaborates with Pharmacy and PNM teams.

The candidate will validate payments according to contracts, participate in workgroups, and assist with onboarding. A CPC/CCS certification is required, with LPN preferred, and remote work options are available.