Medical Coding and Reimbursement Manager

Job Locations US-NY-Pittsford
Posted Date 3 weeks ago(1/30/2018 3:15 PM)
Requisition ID
# of Openings
Job Function
Job Schedule
Regular Full-Time


MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.


The position will be responsible for abstracting data from a complex case file/medical record, identifying ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT and HCPCS codes based on industry standard coding guidelines (CMS, Coding and Reporting Guidelines, National Correct Coding Initiative policies and state and federal coding and reimbursement policies including NCDs and LCDs), application of the correct coding conventions, research complex coding and billing issues, completion of complex payment calculations, performing quality assurance audits on all aspects of the coding process.



  • Audit medical records to ensure compliance with the organization’s coding procedures and standards including, abstraction and assignment of appropriate codes based on clinical data
  • Accurately enter coded data into a system and validate data entered
  • Research correct coding practices, clearly document and share findings with others
  • Review denials and recommend billing and payment corrections
  • Train staff members on the coding processes (both project specific and general coding)
  • Perform Quality Assurance audits on coding process
  • Suggest process improvements to assigned projects
  • Perform other duties as assigned by management

The Ideal Candidate will Possess the Following Additional Education and Experience

  • Bachelor’s Degree from an accredited college or university required, preferably in Health Information Technology required
  • At least ten (10) years of health care billing/coding auditing experience
  • At least three (3) years of managerial experience
  • Excellent organizational, written and verbal communication skills
  • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
  • Ability to work as a team member, as well as independently
  • American Health Information Management Association (AHIMA) certification required
  • Registered Health Information Technician (RHIT) Certification required
  • Certified Coding Specialist (CCS) Certification preferred
  • Knowledge of AHA, AMA, CMS coding rules and regulations
  • Experience with health care reimbursement methodologies including the Inpatient Prospective Payment System (IPPS), Diagnostic Related Groups (DRG), Resource Bases Relative Value Scale (RBRVS), Hospital Outpatient Prospective Payment System (HOPPS) Ambulatory Payment Category (APC), Home Health Prospective Payment System (HH PPS) Health Insurance Prospective Payment System (HIPPS), and Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), and Hierarchical Category Codes (HCC)
  • Use of DRG Grouper software
  • Familiarity of the Outcome and Assessment Information Set (OASIS), Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF PAI), and Worker’s Compensation reimbursement fee schedules and policies preferred 

Physical Requirements:

  • Ability to list or transport objects up to 5 lbs.
  • Ability to sit for up to 90% of time 
  • Ability to travel 10% of time

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.

A committed and diverse workforce is our most important resource.

MAXIMUS is an Affirmative Action/Equal Opportunity Employer.

MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.


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