Job Family:
General Coding
Travel Required:
Clearance Required:
The Sr. Medical Reimbursement Review Coordinator is responsible for coordinating review and appeals with other team members. Will be the point person for the team questions and for all reporting requests. This role will work with the denials team analyzing reimbursement data from third-party payers to identify trends, high-volume errors, and systemic issues impacting revenue. This role involves initiating and tracking appeals, managing fee schedule updates, and collaborating with payers on contract-related matters. The senior coordinator serves as a key liaison between Coding, Revenue Integrity, AR follow-up and Payer Contracting to ensure compliance, optimize reimbursement, and support data-driven decision-making.
The position currently operates within the IDX environment and utilizes Experian Contract Management for fee schedules and contract modeling. The role will transition to Epic as the enterprise moves to a unified EHR and revenue cycle platform.
What You Will Do:
Responsible for coordinating review and appeals with other team members.
Running reports as requested for the leadership team.
Contract modeling for new insurance or insurance changes.
Thoroughly review medical records, including physician notes, lab results and treatment plans to verify accuracy and completeness of claims.
Analyze medical procedures, diagnoses, and services to ensure appropriate coding using ICD-10, CPT and HCPCs codes.
Obtain, format and submit updated fee schedules
Maintain accurate and detailed records of all claims reviews, denials, appeals and resolutions
Prepare reports on claims denial trends, reimbursement outcomes, and other relevant metrics.
Investigate and resolve complex claim denials and appeals, utilizing problem solving skills and analytical abilities.
Identify opportunities to improve the reimbursement process and minimize claim denials.
Analyze reimbursement data to identify underpayments, denial trends, and payer compliance issues.
Review medical records and supporting documentation (e.g., physician notes, labs, treatment plans) to validate claims accuracy.
Audit CPT, HCPCS, and ICD-10 coding to ensure alignment with payer policy and billing guidelines.
Draft and submit appeals, including supporting documentation and references to payer policy or CMS guidelines.
Maintain and update fee schedules in Experian and coordinate with Payer Contracting on modeling and rate validation.
Prepare regular reports on reimbursement variances, appeal success rates, denial root causes, and contract compliance.
Support reconciliation between expected and actual reimbursement based on modeled contract terms.
Serve as a resource for coding, billing, and revenue cycle staff related to complex reimbursement and denial issues.
Collaborate with leadership to identify process improvement opportunities to minimize denials and optimize reimbursement.
Prepare and present findings and recommendations to stakeholders, including senior leadership.
What You Will Need:
Bachelor’s degree in healthcare administration, Health Information Management, or a related field (Relevant experience may be substituted for formal education)
4-6 years of Experian Contract Management Experience.
Strong working knowledge of ICD-10, CPT, and HCPCS coding standards.
Proficiency in interpreting EOBs, remittance advice, and payer contracts.
Experience with Experian Contract Management and fee schedule uploads/maintenance.
Familiarity with IDX and experience preparing for or working within Epic.
What Would Be Nice to Have:
Proficiency in Microsoft Word, Excel, ability to build pivot tables
Certified Professional Coder (CPC) or similar coding credential.
Knowledge of revenue cycle operations, payer policy guidelines, and CMS regulations.
Experience with payer-specific contract terms and reimbursement methodologies.
Ability to present findings, develop narratives, and influence cross-functional teams.
Experience supporting system transitions or EHR migrations.
Strong analytical, problem-solving, and written communication skills.
Ability to work both independently and collaboratively in a high-volume, deadline-driven environment.
#IndeedSponsored
#LI-DNI
What We Offer:
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
About Guidehouse
Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.