Community Care Cooperative

Role Description We are seeking an experienced Accounts Receivable Specialist to join our revenue cycle team. The ideal candidate will have a strong background in professional billing or working in a doctor's office, with a preference for experience in Federally Qualified Health Centers (FQHC). The position requires a detail-oriented and collaborative professional responsible for the implementation, configuration, optimization, and support of Epic’s Resolute Professional Billing (PB) module. This role ensures accurate and efficient billing workflows, charge capture, claims processing, and reimbursement across the healthcare revenue cycle. Familiarity with Massachusetts healthcare regulations, electronic health records (EHRs), and related software is essential for success in this role. - Enter and review charges for accuracy, ensuring proper coding and compliance with payer requirements - Utilize the charge router within Epic to route charges efficiently and accurately to the correct claim workflows - Identify and resolve charge capture errors or discrepancies to prevent billing delays - Prepare, review, and submit electronic and paper claims through Epic and various clearinghouses, ensuring compliance with FQHC billing guidelines and Massachusetts-specific regulations - Apply claim form logic to review and resolve formatting errors before submission - Liaise with insurance companies to resolve discrepancies, missing files, and claim rejections - Analyze claim form logic, including UB-04 and CMS-1500 formats, to ensure proper billing practices are followed - Monitor claims for timely submissions by working closely with follow-up colleagues to address rejected or denied claims - Assist in managing accounts receivable by identifying trends in denials or delays - Perform payer appeals on denied claims as needed - Leverage Epic systems and other EHRs to support billing workflows, payment posting, and reporting - Reconcile daily payment batches to ensure all funds are accounted for and discrepancies are resolved promptly - Monitor unapplied payments and resolve posting errors in a timely manner - Work with banking institutions to ensure accurate deposit processing and address returned or rejected transactions - Function as a point of contact for inquiries related to payment posting and ERA processes - Generate and analyze payment posting and cash reconciliation reports to identify trends and areas for improvement - Maintain and update patient accounts and payer information in the system as needed - Collaborate with IT and billing teams to address system-related issues impacting billing processes - Ensure billing practices comply with FQHC-specific guidelines, Massachusetts healthcare regulations, and payer rules - Stay updated on changes to coding guidelines, billing codes, payer policies, and industry best practices - Participate in internal and external audits as required - Partner with clinical, coding, and health information teams to resolve billing documentation issues - Communicate effectively with insurance companies, patients, and other stakeholders to address billing inquiries - Review billing dashboards as a tool to monitor performance metrics and identify denial trends - Provide feedback to leadership on areas for improvement within billing workflows - Provide excellent customer service when assisting with account inquiries or payment concerns - Other duties as assigned Qualifications - High school diploma or equivalent required; associate or bachelor’s degree in business, healthcare administration, or a related field is preferred Requirements - Knowledgeable of Massachusetts healthcare billing regulations and payer requirements - Minimum of 3-5 years of experience in medical billing, preferably in an FQHC or professional billing setting - Proficiency in Epic resolute professional billing processes - Strong understanding of claim form logic and payer-specific billing requirements - Familiarity with Massachusetts healthcare regulations and insurance processes - Knowledge of medical coding (CPT, ICD-10, HCPCS) and compliance requirements - Excellent attention to detail, organizational skills, and the ability to meet deadlines - Strong communication and problem-solving skills - Solid communication skills across stakeholders, diligence, and problem-solving skills - Experience in Microsoft Office Suite - Must have a strong commitment to quality assurance and exceptional customer service - A strong commitment to C3’s mission Desired Other Skills - Familiarity with the MassHealth ACO program - Familiarity working in Federally Qualified Health Centers (FQHC) - Experience with anti-racism activities, and/or lived experience with racism is highly preferred Benefits

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Certified Risk Coder will be a part of an emerging coding team and coding service that performs retrospective and prospective risk coding reviews and completes provider training for a group of outpatient primary care practices across Massachusetts. This work ultimately leads to a greater understanding of the patient’s complexity while ensuring accurate risk adjustment for patient care. - Serves as an expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and MassHealth Risk Adjustment guidance - Completes record review with a high degree of familiarity with common EHRs, especially Epic, NextGen, Centricity, and eCW - Assists in the compilation and delivery of project reports and facilitates provider-facing interactions - Completes internal audits per quality assurance protocols - Facilitates allowable modifications to the bill to ensure accuracy, involving extensive interaction with FQHC billing and operations staff departments - Assists in chart preparation for providers in advance of appointments - Communicates with provider education team on observed trends to improve documentation - Utilizes population health reporting tools to assist in the identification of patients and conditions in need of review and improvement - Identifies opportunities for FQHC risk score improvement - Performs other duties as assigned Qualifications - 0-5 years of risk coding experience - 0-5 years of medical billing experience in an outpatient setting, preferably in primary care, pediatrics, or behavioral health - Certified Risk Coding (CRC) Certification through AAPC required - In-depth knowledge of medical terminology, anatomy, physiology, and disease process - Knowledge of electronic health record systems: Epic, NextGen, Centricity, and eCW preferred - Expertise in Medicaid and/or Medicare risk adjustment models - Billing compliance expertise required - Self-starter; exercises high degree of initiative, judgement, discretion and decision making to achieve objectives - Familiarity with Excel - Performs with great integrity and produces accurate work with close attention to detail, especially in the completion of final deliverables to internal and external stakeholders Requirements - The Certified Risk Coder must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively as a member of an emerging team within a fast-paced organization. - Must communicate clearly and succinctly in writing and verbally across multiple tiers of the organization, from leadership to individual providers and health center staff. - Strong commitment to quality assurance and exceptional customer service. Desired Other Skills - Familiarity with the MassHealth ACO program - Familiarity with Federally Qualified Health Centers - Experience with anti-racism activities, and/or lived experience with racism is highly preferred Company Description Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.