J29

Role Description This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. - Perform blinded Independent Review (IRR) clinical evaluations, assessing medical necessity, appropriateness of care, and adherence to Medicare guidelines. - Collaborate in the development of rebuttals and contribute to informed escalation decisions as needed. Qualifications - 10+ years clinical practice; experience in peer review, utilization review, or appeals. - Familiarity with CMS/QIO processes preferred. - Licensed MD or DO in the U.S.; active, unrestricted license required. Company Description J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. - Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.

Role Description This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. The Program Manager provides overall leadership and accountability for audit, survey, analytics, and governance; serves as primary CMS point of contact and ensures performance, quality, and delivery. Key Responsibilities - Lead healthcare quality improvement initiatives, ensuring high-quality services and timely delivery of all project deliverables. - Design and execute both quantitative and qualitative research methodologies, including survey development and text mining analysis. - Apply process improvement frameworks, including the Plan-Do-Study-Act (PDSA) approach, to develop, implement, and refine quality improvement strategies. - Manage projects at a strategic level, including overseeing timelines, deliverables, and stakeholder relationships across internal and external partners. - Conduct performance measurement, quality assurance activities, project evaluations, and analysis of results to inform decision-making. - Collaborate closely with project management leadership and cross-functional teams to ensure the successful planning, launch, and completion of initiatives. - Oversee project management functions, including personnel management, project planning, coordination of daily activities, data analysis, and reporting using established tools and methodologies. - Identify opportunities for innovation and improvement by applying critical thinking and problem-solving skills, and implement solutions that drive large-scale change. - Communicate clearly and effectively, both verbally and in writing, with a wide range of stakeholders, including executive leadership and external audiences. Qualifications - 15+ years in CMS or federal healthcare programs - Program Director on large programs or contracts - Strong survey and audit experience - PMP or equivalent certification Requirements - Experience in healthcare quality improvement, demonstrating the ability to provide high-quality services and on-time submission of deliverables; - Experience leading both quantitative and qualitative methodologies, including expertise in survey methodology and text mining; - Experience with process improvement and the Plan-Do-Study-Act (PDSA) approach in developing, implementing, and revising quality improvement initiatives; - Demonstrated ability to manage projects at a strategic level, including effectively navigating internal and external customer relationships; - Experience in performance measurement, quality assurance, project evaluations, and result analysis; - Demonstrated skill in collaborating closely with project management leadership teams and project managers, liaising with cross-functional teams to ensure the timely and successful launch and completion of both internal and external activities; - Proficient in project management, including managing personnel, project planning, coordination of daily activities, data analysis, and constructive reporting utilizing project management techniques and tools; - Demonstrated skill in critical thinking, innovation, and problem-solving, with a track record of recommending and implementing effective solutions for large-scale change; - Exceptional oral and written communication skills, capable of engaging effectively with both executives and the general public. Company Description J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Coding Compliance Specialist is responsible for overseeing and evaluating assigned Risk Adjustment Data Validation (RADV) medical record review (MRR) work performed under the contract. This role ensures compliance with CMS RADV guidelines, coding standards, and risk adjustment policies while maintaining the highest quality and accuracy in medical record documentation. This is a part-time, remote position with flexible scheduling, ideal for experienced professionals seeking autonomy and work-life balance. Key Responsibilities - Ensure adherence to CMS RADV payment and risk adjustment policies. - Provide expert guidance on coding and documentation standards, including ICD-CM, HCC, and Risk Adjustment. - Review escalated Medicare RADV medical record cases and resolve complex issues. - Maintain quality assurance and compliance across all RADV review activities. - Collaborate with stakeholders to improve processes and ensure contractual obligations are met. - Conduct medical record, coding, and policy research. - Develop and deliver training programs related to RADV and coding compliance. - Perform medical record reviews involving PHI/PII, identify conflicting documentation, and provide coding clarifications. Qualifications - Prior experience working directly on the CMS RADV contract is required. - Minimum 5 years of supervisory experience in medical record review, preferably RADV. - Proven expertise in reviewing escalated Medicare RADV medical record cases. - In-depth knowledge of RADV Medical Record Review (MRR) processes, ICD-CM coding standards, CMS RADV payment and risk adjustment policies, and documentation guidelines. Education & Certification - Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA). - RHIT, RHIA, CCS, CPC, CRC. - Advanced knowledge of coding systems and compliance regulations. Skills & Competencies - Strong analytical and problem-solving skills. - Excellent communication and leadership abilities. - Detail-oriented with a commitment to accuracy and compliance. - Ability to manage multiple priorities and meet deadlines.