Remote Medical Billing & Prior-Authorization Expert (SME)

Partners in Digital Health; Northern (KY); Hybrid; USD 99,000 - 136,000; Part time

Job summary

Exponent is hiring medical billers, coders, prior authorization and insurance-verification specialists as subject matter experts for a healthcare technology client. This is a remote, part-time, contract engagement.

No protected health information is involved. You will evaluate revenue-cycle and authorization workflows in a simulated environment and document where the environment differs from real-world practice.

Qualifications

• 5+ years in revenue cycle, coding, prior authorization, or pharmacy.
• 3+ years of daily, hands-on use of Availity, 3M Codefinder, CoverMyMeds, RightFax, athenahealth, or MDLand iClinic.
• Currently employed in the field, or left within the past two years.
• CPC, CPB, CCS, RHIT, RHIA, or CPhT preferred.
• Working knowledge of CPT, ICD-10, and HCPCS for billing and coding roles.
• For 3M Codefinder: inpatient coding or coding audit experience with groupers and principal/secondary diagnosis selection.
• For CoverMyMeds: daily medication prior-authorization work.
• Clear written communication.

Responsibilities

• Complete assigned workflows in a simulated environment: eligibility and benefits verification, authorization submission and appeals, claim generation and scrubbing, remittance review, charge entry, coding and abstracting, and fax routing
• Identify steps that fail, behave differently from the production system, or are missing
• Document findings in structured forms and short written notes
• Attend a remote onboarding session and periodic check-ins

Skills

Revenue cycle experience

Coding & prior authorization

Availity

3M Codefinder

CoverMyMeds

RightFax

athenahealth

MDLand iClinic

CPT, ICD-10, HCPCS knowledge

Written communication

Education

CPC, CPB, CCS, RHIT, RHIA, or CPhT

Job description

Exponent is hiring medical billers, coders, prior authorization and insurance-verification specialists as subject matter experts for a healthcare technology client. This is a remote, part-time, contract engagement.

No protected health information is involved. You will evaluate revenue-cycle and authorization workflows in a simulated environment and document where the environment differs from real-world practice.