Remote Medical Billing & Prior Authorization SME (Contract)

AHIMA; United States; Remote; USD 99,000 - 136,000; Part time

Job summary

Exponent is seeking medical billers, coders, prior-authorization and insurance-verification specialists as subject matter experts for a healthcare technology client. This remote, part-time contract engagement involves evaluating revenue-cycle workflows in a simulated environment and documenting differences from real-world practice.

Responsibilities include completing workflows, identifying gaps, and documenting findings.

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.
• 3M Codefinder: inpatient coding or coding audit experience with groupers and principal/secondary diagnosis selection.
• CoverMyMeds: daily medication prior-authorization work.
• Clear written communication.

Responsibilities

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

Skills

Revenue cycle

Prior authorization

Written communication

Education

CPC/CPB/CCS/RHIT/RHIA/CPhT

Tools

Availity

3M Codefinder

CoverMyMeds

RightFax

athenahealth

MDLand iClinic

Job description

Exponent is seeking medical billers, coders, prior-authorization and insurance-verification specialists as subject matter experts for a healthcare technology client. This remote, part-time contract engagement involves evaluating revenue-cycle workflows in a simulated environment and documenting differences from real-world practice.

Responsibilities include completing workflows, identifying gaps, and documenting findings.