HCCS - Healthcare Coding & Consulting Services

• Manage the credentialing and recredentialing process for approximately 132 providers across 12 healthcare facilities. • Verify provider licensure, certifications, education, work history, malpractice coverage, and other required documentation. • Prepare and submit credentialing, recredentialing, payer enrollment, and hospital privilege applications. • Maintain accurate provider records and credentialing databases. • Monitor expiration dates and coordinate timely renewals to maintain compliance. • Communicate with providers, payers, and facility administrators to resolve credentialing issues and obtain required documentation. • Ensure compliance with NCQA, CMS, Joint Commission, payer, and organizational standards. • Generate reports and maintain organized workflows to support credentialing operations.

• Support orthopedic revenue cycle and denial management operations • Understand the full revenue cycle, including coding, claim submission, payer follow-up, denial resolution, and appeals • Initially focus on orthopedic denials and ERISA appeals • Support billing, coding, accounts receivable, claims follow-up, and denial management needs across multiple specialties

• Perform concurrent and retrospective reviews of inpatient medical records to improve the quality and accuracy of clinical documentation • Identify opportunities to clarify documentation that supports accurate code assignment, severity of illness, risk of mortality, quality metrics, and reimbursement • Collaborate with physicians through compliant query practices to obtain complete and accurate documentation • Partner with inpatient coding professionals to ensure documentation supports appropriate code assignment and accurate DRG assignment • Monitor assigned patient populations throughout hospitalization and perform follow-up documentation reviews as needed • Apply current CMS regulations, ICD-10-CM/PCS coding guidelines, MS-DRG methodologies, and Coding Clinic guidance • Promote provider education and documentation best practices that improve documentation integrity and patient outcomes • Analyze documentation trends and identify opportunities for process improvement • Participate in multidisciplinary collaboration to support documentation integrity initiatives • Maintain productivity, quality, and compliance standards established by HCCS and our client partners.