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Role Description

RVC Reviewers perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims—including Part A/B, DMEPOS, and Home Health/Hospice—to assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs). They apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules, and document clear, accurate findings for each claim.

• Participate in dispute resolution by re-examining claims and providing supporting documentation.
• Support quality assurance through audits and ongoing training.
• Maintain compliance with CMS security and privacy standards.
• Collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities.

Qualifications

• 5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment.
• 3+ years working in a productivity-based claims or case working environment, out of a queued case management system.
• 3+ years working remotely with various technology systems.
• 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program.
• Experience with low-code, no-code case management systems as an end-user is preferred but not required.
• Certified from an accredited association such as the American Association of Professional Coders (AAPC) or American Health Information Management Association (AHIMA).
• May also be Registered Health Information Administrators (RHIA) and Registered Health Information Technicians (RHIT); credentialed by AHIMA in their field of health information.

Requirements

• Location: Remote (United States)
• Salary: $45,000-60,000

Company Description

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.