Description

MEDICAL CODING & RUCR CASE REVIEW SPECIALIST (1099 CONTRACTOR)

 
1. JOB DESCRIPTION

Overview

We are seeking an experienced medical coding professional (RHIA, RHIT, CCS, CCS-P, CMRS, CPMA, CPC, with active certifications) with 3+ years of U.S. coding experience to support structured case review and reimbursement benchmarking work (RUCR system).

This role focuses on accurate coding review, validation of billing outputs, and selective documentation checks to ensure case results are correct, consistent, and defensible within a structured reimbursement benchmarking system.

This is a hands-on execution role, not a management, consulting, or sales position.

 
What You Will Do

Review medical cases using our RUCR system and established workflows
Check medical codes (CPT, HCPCS) for accuracy and consistency with documentation and billing rules
Review RUCR outputs to ensure:
correct coding assignments
proper application of modifiers (including bilateral rules, when applicable)
correct application of reimbursement logic and edits
Verify key documentation details when needed, such as:
timed physical therapy services (accurate documentation of minutes)
evaluation and management coding levels (e.g., 99204, 99205, 99214, 99215)
Identify and flag coding, documentation, or data entry errors
Use structured tools and workflows where available, and apply consistent professional judgment where they are not
When needed, clearly explain coding decisions or errors using documentation and coding guidelines in a professional, written format
 
What We Are Looking For

Active RHIA, RHIT, CCS, CCS-P, CMRS  or CPC, with active certification(s)
Minimum 3+ years of U.S. medical coding experience
Strong knowledge of CPT, HCPCS, and modifier rules
Experience with inpatient, physician, outpatient, ASC, or hospital outpatient billing environments strongly preferred, particularly in:
orthopedics
pain management
physical therapy
spine or procedural specialties
Familiarity with CPT and HCPCS coding in these environments is more important than advanced diagnosis coding expertise
Familiarity with usual, customary and reasonable fee structures and benchmarking tools
Familiarity with DRG-based inpatient reimbursement systems is a plus but not required
 
Core Skills Required for Success

Ability to accurately review coded medical cases and match them to supporting documentation
Strong attention to detail and consistency in applying coding rules
Ability to identify coding, documentation, or data entry errors
Ability to follow structured workflows while applying sound professional judgment when needed
Ability to clearly explain coding decisions or errors in writing when required
 
Written Communication Requirement

Strong written communication skills are required, including the ability to clearly and accurately explain coding decisions using proper grammar, professional tone, and coding guidelines.

Experience preparing audit findings, coding summaries, or structured review notes is a plus.

 
Work Style Fit

We are looking for someone who:

Works well in structured environments with defined processes
Is consistent, reliable, and detail-oriented
Can take direction and apply feedback without resistance
Is focused on accuracy and quality over speed alone
Is comfortable in a production-oriented workflow
 
Not a Fit For This Role

This role is not suited for individuals who are:

Seeking a consulting or advisory-only position
Primarily focused on business development or entrepreneurship
Uncomfortable working within structured workflows or guidelines
Lacking hands-on coding experience in U.S. healthcare settings
 
Work Environment

Independent contractor (1099)
Work from home (remote position)
Flexible schedule – you set your own hours
Work is structured around deadlines and case turnaround expectations rather than fixed daily hours
Up to ~35 hours/week depending on workload and case volume
Paid test cases during evaluation period
Long-term opportunity for the right candidate
 
Compensation

Hourly rate based on experience and performance during paid test cases:
$35 – $43 per hour (1099 contractor)

Higher rates may be considered for candidates with strong ASC, outpatient, surgical, or audit experience demonstrated during evaluation.

 
Why This Role Exists

This role supports a structured reimbursement benchmarking system (RUCR) designed to ensure accurate, consistent, and defensible case review outputs. The goal is to support scalable case processing while maintaining high-quality coding integrity.