Remote Medical Coding & Prior Authorization Specialist

Integra Partners; Troy (MI); Hybrid; USD 58,500 - 71,500; Full time

Benefits offered by this job

401(k) company match

Company-paid life insurance

Medical, Vision, and Dental benefits

Paid Time Off

Paid Parental Leave

Sick Time

Company holidays and floating holidays

Career development opportunities

Job summary

Integra Partners is seeking a Medical Coding Specialist to support Utilization Management, health plan implementations, and prior authorization program development. The role involves researching and interpreting HCPCS, CPT, and ICD-10 guidance to support accurate coding and client deliverables across Medicare, Medicaid, Commercial, and Marketplace lines.

The Specialist collaborates with clinical, operational, compliance, business development, and client teams to ensure coding recommendations are

Qualifications

• Minimum of 3 years of medical coding experience.
• Experience with HCPCS, CPT, and ICD-10 coding required.
• Experience supporting health plans, utilization management, prior authorization, DMEPOS, or payer operations preferred.
• Knowledge of Medicare, Medicaid, and Commercial coding methodologies preferred.

Responsibilities

• Research unfamiliar coding scenarios using available coding resources and regulatory guidance.
• Identify questions or areas requiring clarification early in the work process.
• Present questions with supporting research and a recommended approach when seeking guidance.
• Participate in discussion and resolution of coding issues with internal stakeholders.
• Develop, validate, and maintain prior authorization code lists and coding reference materials.
• Support implementation of new health plans, benefit designs, and coding configurations.
• Review client specific coding requirements and ensure recommendations align with contractual and regulatory requirements.
• Perform thorough self review of work prior to submission to ensure accuracy, completeness, and consistency.

Skills

HCPCS/CPT/ICD-10

Regulatory knowledge

Prior authorization understanding

Research & problem solving

Attention to detail

Collaboration

Education

CPC/CCS/RHIT certifications

High school diploma

Associate or Bachelor in HIM/Healthcare Admin

Job description

Integra Partners is seeking a Medical Coding Specialist to support Utilization Management, health plan implementations, and prior authorization program development. The role involves researching and interpreting HCPCS, CPT, and ICD-10 guidance to support accurate coding and client deliverables across Medicare, Medicaid, Commercial, and Marketplace lines.

The Specialist collaborates with clinical, operational, compliance, business development, and client teams to ensure coding recommendations are