Med-Metrix

Role Description The Clinical Documentation Integrity Specialist focuses on the accuracy, completeness and consistency of inpatient clinical documentation to support coding and reporting of high-quality healthcare data. This role involves: - Performing concurrent chart reviews to validate that the clinical documentation in the medical record appropriately describes the patient’s severity of illness, complexity of care, and risk of mortality. - Utilizing advanced knowledge of disease processes and medications to analyze current documentation and identify gaps. - Facilitating appropriate modifications to documentation through extensive interactions and collaborations with providers, coding, quality, and case management teams. - Serving as an effective change agent and educator for providers and interdisciplinary care teams. Qualifications - Minimum of 3 years of experience in inpatient clinical documentation improvement role required. - Minimum of 5 years of nursing experience in adult acute care (med/surg, critical care, emergency, or PACU) required. - Certification minimum requirement – CCDS and/or CDIP. - Current state Registered Nursing license required. - Coding credential highly preferred (CCS, CPC, CCS-P). - Current state Registered Nurse license highly preferred. - Fundamental knowledge of ICD-10 Official Coding Guidelines and DRG Reimbursement Systems. - Demonstrated skills in analytical thinking and problem solving. - Excellent communication and people skills. - Self-motivated and able to work independently without close supervision. - Proficient in the use of computers including Microsoft Office (Word, Excel, PowerPoint, etc.), Outlook, and other applications necessary to perform the CDS role. Requirements - Analyzes medical records to identify incomplete or inaccurate documentation related to diagnoses, treatments, and procedures. - Periodically analyzes coding data to identify documentation variations and determine the cause and appropriateness of such variation; presents findings to management. - Works closely with healthcare professionals to clarify and obtain additional information needed for accurate documentation. - Facilitates modification to clinical documentation supporting the clinical picture/level of severity rendered to all patients. - Collaborates with healthcare providers and stakeholders to clarify and improve documentation. - Provides support to medical coders by ensuring documentation supports the assigned codes and compliance with coding guidelines. - Communicates effectively with coding teams to address coding-related issues and promote accurate code assignment. - Conducts training sessions for healthcare staff on proper documentation practices, coding guidelines, and compliance requirements. - Utilizes data analytics to identify trends, patterns, and areas for improvement in documentation accuracy and completeness. - Monitors daily DRG assignment, DRG reports, and tracking areas for performance improvement. - Demonstrates an understanding of current Quality Measure Initiatives including Value Based Purchasing, Pay for Performance, and Readmission criteria. - Ensures documentation aligns with regulatory requirements, coding standards, and healthcare policies. - Conducts regular audits to assess the quality of clinical documentation and identify areas for improvement. - Participates in quality improvement initiatives related to clinical documentation and coding accuracy. - Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with HIPAA standards. - Limits viewing of PHI to the absolute minimum necessary to perform assigned duties. - Understands and complies with Information Security and HIPAA policies and procedures at all times. Company Description

Role Description The Collections Representative supports our Collections department in its debt recovery process by contacting debtors to make payment arrangements or determine settlements on behalf of our clients. Must be assertive in pursuing payments in a professional manner and in accordance with FDCPA guidelines. - Initiate collection calls daily - Arrange payments of outstanding balances - Set up payment plans for parties unable to repay their debt in full - Send correspondence regarding delinquent accounts - Provide daily/weekly updates to management - Contact health insurance carriers - Manage a large volume of patient accounts per week - Coordinate with the legal department on skip tracing, asset location, and garnishments - Other duties as assigned - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards - Understand and comply with Information Security and HIPAA policies and procedures at all times - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications - High School Diploma or equivalent required, Associate’s Degree preferred - Motivated by weekly goals and monthly quotas - Proficiency in Microsoft Office Suite - Strong interpersonal skills, ability to communicate well at all levels of the organization - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses - High level of integrity and dependability with a strong sense of urgency and results oriented - Excellent written and verbal communication skills required Requirements - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes - Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear - Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress - Work Environment: The noise level in the work environment is usually minimal - Hours are Monday - Friday 9:00 a.m. - 5:00 p.m. with one late night per week (11:00 a.m. - 7:00 p.m.) Company Description Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Role Description The Clinician, Denials Prevention, uses their clinical and administrative skills to analyze denials and appeal outcomes; share opportunities with clients to reduce first pass denials by ensuring proper patient status, authorizations, clinical documentation opportunities, staff education, and collaboration with other departments. - Maintain the integrity of information in each appeal produced - Review a high volume of written appeals to ensure information is medically accurate - Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment - Make recommendations for workflow revisions to improve efficiency and reduce denials - Present case studies and recommendations to clients and impacted stakeholders - Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate - Identify opportunities for process improvement and actively participate in process improvement initiatives, internally and externally - Other duties as assigned - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards - Understand and comply with Information Security and HIPAA policies and procedures at all times - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications - Bachelor’s degree in a health-related field; 2 years of experience may be considered in lieu of a degree in addition to the required experience. LPN or RN preferred. - Two years of recent experience in hospital case management, hospital prior authorization, or utilization management - Experienced in medical chart review - Claim-related appeal writing experience preferred - Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms - Experience with MCG and/or InterQual guidelines preferred - Proficiency in Microsoft Office Suite - Strong interpersonal skills, ability to communicate well at all levels of the organization - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses - High level of integrity and dependability with a strong sense of urgency and results oriented - Excellent written and verbal communication skills required - Gracious and welcoming personality for customer service interaction Requirements - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Company Description Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Role Description The Manager, Commercial Operations is responsible for building and maintaining the operational infrastructure that enables Sales and Marketing to function as a measurable, pipeline-driven contributor to revenue growth. This role owns the systems, workflows, reporting, and cross-functional processes required to improve pipeline visibility, funnel conversion, campaign accountability, forecasting discipline, and overall revenue performance. The Manager, Commercial Operations partners closely with Sales, Marketing, Finance, Operations, and executive leadership to establish scalable revenue processes, maintain CRM and marketing automation data integrity, develop performance dashboards, coordinate campaign and lead management workflows, and support planning activities tied to new business growth. - Build, maintain, and improve revenue operation processes by aligning resources across Sales, Marketing, Finance, and executive reporting functions. - Identify opportunities to streamline processes, reduce manual effort, improve data accuracy, increase accountability, and scale revenue operations as the business grows. - Oversee implementation of marketing campaign strategy that includes annual sales planning, quota development, territory planning, pipeline reviews, forecasting, and executive or board reporting that aligns with the overall strategic vision of the Sales leadership. - Establish campaign targets, lead routing rules, MQL, SAL, and SQL tracking, attribution processes, and closed-loop performance measurement. - Align audience targeting of webinars, events, and on-demand content generation with overall campaign execution. Manage lead handoff, sales follow-up, and post-program reporting. - Maintain revenue technology tools including Salesforce, Marketo, ZoomInfo, Microsoft Office, reporting platforms, shared drives, and other Sales and Marketing systems for efficient and effective use by sales and marketing teams including creating and updating processes and procedures, databases, and technology configurations. - Actively participate in identifying opportunities for the advancement of the Sales and Marketing Teams, development of new business, and closing of Sales as needed. - Other duties as assigned. - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. - Understand and comply with Information Security and HIPAA policies and procedures at all times. - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties. Qualifications - Bachelor’s degree in Sales, Marketing, Business Management, Business Analytics, or a related field preferred. - 3–5 years of experience in revenue operations, sales operations, marketing operations, business operations, or a similar role; healthcare revenue cycle management experience preferred. - 2-3 years’ experience in SQL and MQL required. - Working knowledge of software Marketo, Salesforce, and Adobe required. - Ability to translate business objectives into scalable processes, dashboards, workflow systems, and operating cadences. - Excellent analytical, organizational, and stakeholder management skills. - Proven ability to manage multiple priorities, identify process gaps, improve accountability, and meet deadlines in a fast-paced environment. - Proficiency in Microsoft Office Suite. - Strong interpersonal skills, ability to communicate well at all levels of the organization. - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses. - High level of integrity and dependability with a strong sense of urgency and results oriented. - Excellent written and verbal communication skills required. Requirements - Occasional travel may be required. - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands - While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands - The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment - The noise level in the work environment is usually minimal. Company Description Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Role Description The Licensed Appeal Writer supports the Company by reviewing insurance claims denied for payment on behalf of our client hospitals. Working closely with nurses and other team members, the Licensed Appeal Writer creates appeal letters in support. - Review denied insurance claims - Review patients’ medical files - Develop strategies to reverse claim denials - Create written appeals - Manage and organize appeal workflow based on internal, client-based, and insurance-driven deadlines - Other duties as assigned - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards - Understand and comply with Information Security and HIPAA policies and procedures at all times - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications - 4-year degree or work equivalency required - Must hold an active license as a Physician's Assistant (PA), Registered Nurse (RN), Nurse Practitioner (NP), Licensed Practical Nurse (LPN), Physical Therapist (PT), Occupational Therapist (OT), or an equivalent professional license - Must be able to prioritize workload based on strict deadlines - Must be tech-savvy with ability to quickly learn new software - Must possess a high level of reading comprehension and ability to analyze medical information and terminology - Proficiency in Microsoft Office Suite - Strong interpersonal skills, ability to communicate well at all levels of the organization - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses - High level of integrity and dependability with a strong sense of urgency and results oriented - Excellent written and verbal communication skills required - Gracious and welcoming personality for customer service interaction Requirements - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands - While performing the duties of this job, the employee is occasionally required to move around the work area - Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones - Extend arms; kneel; talk and hear Mental Demands - The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment - The noise level in the work environment is usually minimal.

Role Description The Senior Data Engineer designs, builds, and maintains scalable data pipelines and architectures to support the Denials AI workflow under the guidance of the Team Lead, Data Management. This role ensures data is reliable, compliant with HIPAA, and optimized. - Collaborate with the Team Lead and cross‑functional teams to gather and refine data requirements for Denials AI solutions - Design, implement, and optimize ETL/ELT pipelines using Python, Dagster, DBT, and AWS data services (Athena, Glue, SQS) - Develop and maintain data models in PostgreSQL; write efficient SQL for querying and performance tuning - Monitor pipeline health and performance; troubleshoot data incidents and implement preventive measures - Enforce data quality and governance standards, including HIPAA compliance for PHI handling - Conduct code reviews, share best practices, and mentor junior data engineers - Automate deployment and monitoring tasks using infrastructure-as-code and AWS CloudWatch metrics and alarms - Document data workflows, schemas, and operational runbooks to support team knowledge transfer - Other duties as assigned - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards - Understand and comply with Information Security and HIPAA policies and procedures at all times - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications - Bachelor’s or master’s degree in Computer Science, Data Engineering, or related field - 5+ years of hands‑on experience building and operating production‑grade data pipelines - Solid experience with workflow orchestration tools (Dagster) and transformation frameworks (DBT) or other similar tools such as Microsoft SSIS, AWS Glue, Air Flow - Strong SQL skills on PostgreSQL for data modeling and query optimization or any other similar technologies (Microsoft SQL Server, Oracle, AWS RDS) - Working knowledge with AWS data services: Athena, Glue, SQS, SNS, IAM, and CloudWatch - Basic proficiency in Python and Python data frameworks (Pandas, PySpark) - Experience with version control (GitHub) and CI/CD for data projects - Familiarity with healthcare data standards and HIPAA compliance - Experience mentoring or leading small technical efforts - Proficiency in Microsoft Office Suite - Strong interpersonal skills, ability to communicate well at all levels of the organization - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses - High level of integrity and dependability with a strong sense of urgency and results oriented - Excellent written and verbal communication skills required Work Conditions - Work Set-Up: Work From Home - Work Schedule: US hours, night shift; must be flexible to accommodate business needs - Physical Demands: - Occasionally required to move around the work area - Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones - Extend arms; kneel; talk and hear - Mental Demands: - Must be able to follow directions, collaborate with others, and handle stress - Work Environment: The noise level in the work environment is usually minimal Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Role Description The Contract Management Coordinator will assist the Contract Management Department in all administrative functions. The Contract Management Coordinator will work with the team on tasks that will allow them to focus on the loading and validating contracts. - Pull all Government fee schedules and upload into Pricer - Download Medicare Fee Schedules and upload to Pricer for global use - Download all state Medicaid schedules (Annual or quarterly depending on state) and upload to Pricer for global use - Download all Government Factors needed by 3M for pricing and submit to Dev Team - Provide factors in an organized manner to Dev team for system loading - Pull all state Workers Comp/No Fault Fee Schedules and upload into Pricer - Run all Contract Management Volume Reports Monthly/Quarterly - Provide Internal and External pricing confirmation and feedback - Provide 24 hour turn around on specific pricing questions to External and Internal customers - Provide Clients with Pricing Contract Glances as requested - Attend all team meetings and take and distribute notes as required - Maintain all Workers Comp and No Fault client contracts and fee schedules - Run validation reports requested by Management - Assist in gap analysis for new and existing clients - Complete contract inventory on semiannual basis for all clients to confirm we are up to date with contracts - Assist Department Management with any additional tasks/projects - Other duties as assigned - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards - Understand and comply with Information Security and HIPAA policies and procedures at all times - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications - High school diploma or equivalent required, Bachelor’s degree preferred - 2 - 3 years minimum experience of Medicare, Medicaid & state Workers Comp/No Fault websites to obtain pricing fee schedules and information required - Highly organized and adept in handling documents - Minimum 1-year basic knowledge of the Managed Care industry, billing and/or healthcare contracting required - Ability to work in a high paced environment and be able to multitask - Strong interpersonal skills, ability to communicate well at all levels of the organization - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses - High level of integrity and dependability with a strong sense of urgency and results oriented - Excellent written and verbal communication skills required - Gracious and welcoming personality for customer service interaction Requirements - Work Schedule: Monday - Friday 9PM - 5AM PHT (Night Shift) - Work Set-Up: Full Time Permanent Remote - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands - While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands - The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment - The noise level in the work environment is usually minimal.

Role Description The Clinical Documentation Integrity DRG Downgrade Specialist is responsible for reviewing, analyzing, and responding to payer‑initiated DRG downgrades. The role ensures accurate DRG assignment, protects revenue integrity, and supports compliant documentation practices through detailed review, appeal preparation, and performance tracking. The specialist serves as an effective change agent, acting as a resource and educator for providers and interdisciplinary care teams to improve documentation quality, coding accuracy, and audit readiness. Duties & Responsibilities - Analyze payer DRG downgrade notifications to determine validity based on ICD‑10‑CM/PCS coding guidelines, clinical indicators, and documentation sufficiency. - Conduct comprehensive medical record reviews to validate principal diagnosis, secondary diagnoses, procedures, MCC/CC capture, and DRG assignment accuracy. - Write clear, persuasive, evidence‑based appeal letters that incorporate clinical rationale, coding guidelines, and regulatory references to support the original DRG. - Submit appeals within required timelines and track each case through all stages of the appeal lifecycle, including initial review, reconsideration, and final determination. - Maintain detailed logs of downgrade cases, outcomes, appeal success rates, and turnaround times to support throughput monitoring, trend analysis, and performance reporting. - Identify patterns in payer downgrades and escalate systemic issues or documentation vulnerabilities to leadership. - Collaborate with internal teams and providers to clarify ambiguous documentation and ensure clinical specificity. - Identify documentation gaps or inconsistencies and provide targeted feedback to improve provider documentation practices. - Participate in internal audits, retrospective reviews, and quality assurance processes related to DRG validation, coding accuracy, and documentation completeness. - Assist in developing or refining documentation templates, provider education materials, and query processes to support ongoing CDI improvement. - Ensure all coding and documentation practices align with CMS regulations, AHA Coding Clinic guidance, and organizational compliance policies. - Stay current on payer audit trends, regulatory updates, DRG methodology changes, and emerging risk areas that may impact DRG assignment or audit outcomes. - Support compliance initiatives by identifying potential vulnerabilities and recommending corrective actions or process improvements. - Partner with internal teams to resolve complex DRG issues and ensure alignment across departments. - Participate in provider education sessions, meetings, and case reviews to promote accurate documentation and DRG integrity. - Communicate effectively with leadership regarding trends, risks, and opportunities for improvement in documentation and coding practices. - Serve as a subject‑matter expert for DRG downgrade processes, providing guidance and support to internal teams. - Other duties as assigned. - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. - Understand and comply with Information Security and HIPAA policies and procedures at all times. - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties. Qualifications - Bachelor’s degree in Nursing required. - Minimum of 3 years of experience in an inpatient clinical documentation improvement role. - Minimum of 5 years nursing experience in adult acute care in medical/surgical, critical care, emergency, and/or PACU setting. - RN license required. - CCDS and/or CDIP required. - CCS or CIC certification required. - Demonstrated inpatient coding experience in an acute care setting. - Prior experience managing DRG downgrades, including appeal letter development. - Deep knowledge of ICD-10-CM/PCS, ICD-10 Official Coding Guidelines and both MS and APR DRG Reimbursement Systems. - Ability to interpret complex clinical documentation across multiple specialties. - Proficiency with EMR systems, encoder tools (e.g., 3M, Optum) and CDI workflow and reporting tools. - Proficiency in Microsoft Office Suite. - Strong interpersonal skills, ability to communicate well at all levels of the organization. - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses. - High level of integrity and dependability with a strong sense of urgency and results oriented. - Excellent written and verbal communication skills required. Working Conditions - Ability to work outside of normal business hours as needed. - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands - While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands - The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment - The noise level in the work environment is usually minimal. Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Role Description The Director, Patient Access will provide leadership to RCM/AR Follow Up Managers and their teams, including supervision of staff, reviewing of processes, and providing recommendations for improvement of operations. The goal is to meet or exceed national AR KPI benchmarks and client specific KPI’s. Responsibilities include: - Plan, organize and direct overall operations of the Insurance Verification and Authorization Team as it relates to patient intake and pre-visit services. - Serve as the visionary for Patient Access workflow and work in conjunction with Med-Metrix leadership to set target performance levels. - Ensure that Med-Metrix stays current with payer regulations and industry requirements and/or trends. - Identify opportunities/risks and establish and convey to VP, Patient Access Services and other Med-Metrix leaders, providing solutions and plans to execute. - Maintain an overall objective of maximization of patient satisfaction, reduction of eligibility, benefit and authorization denials and the minimization of write-offs/non-collectible adjustments. - Proactively monitor KPIs, process metrics and SLAs to ensure the department is achieving best practice performance. - Review weekly and monthly reporting, and utilize other work tools to review trends in RTE Errors, work queue volumes and denials and proactively address potential issues. - Provide concise reporting to Executive Leadership on performance benchmarks as they relate to national and client based KPI’s. - Provide management and supervisory duties related to educating and training staff, evaluating staff performance and monitoring productivity. - Interview, hire, train, evaluate, and develop subordinate staff, where applicable. - Develop and maintain quality control programs, including in-depth and individual performance reviews. - Orient new hires and provide in-services and training, continuing education, and development related to those functional areas of responsibility. - Mentor Manager, Patient Access on strategic thinking, analysis of metrics and effective client communication. - Perform a variety of tasks including development of front-end processes, training material, control reports and KPIs. - Serve as facilitator and lead on Med-Metrix front-end implementations, finding the “best practice” solutions looking at the whole process. - Represent Med-Metrix on Client Projects and provide communication back to Med-Metrix executive leadership. - Provide professional and summarized quantitative analysis to Med-Metrix and client executives through presentation and reporting. - Provide summarized analysis to Operations Leadership and staff. - Attend external seminars/training as needed. - Other duties as assigned. - Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. - Understand and comply with Information Security and HIPAA policies and procedures at all times. - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties. Qualifications - Bachelor’s Degree. - 7 yrs. min. experience directing and leading a physician business office/professional services CBO or hospital Patient Access department. - Must be experienced in and have extensive working knowledge of all systems related to the revenue cycle. - Ability to work well individually and in a team environment. - Must be reliable, responsible, goal oriented and flexible. - High degree of integrity including ability to successfully deal with sensitive or confidential information. - Proficiency in Microsoft Office Suite. - Strong interpersonal skills, ability to communicate well at all levels of the organization. - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses. - High level of integrity and dependability with a strong sense of urgency and results oriented. - Excellent written and verbal communication skills required. - Gracious and welcoming personality for customer service interaction. Requirements - Occasional travel to client sites. - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. - Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. - Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. - Work Environment: The noise level in the work environment is usually minimal.

Role Description The Denials Management Clerk supports the Denial Management Department in the denials process for client hospitals. In this role, the Denials Management Clerk gathers and disseminates information from hospitals, physicians, and insurance companies pertaining to referred claims denied. - Manually enter new cases referred from clients into database as needed - Update database with information gathered from correspondence - Set follow-up reminders in Outlook - Review daily reports for updates and due dates - Send updates on document requests received throughout the day - Send documentation to insurance carriers via portals, email, mail or fax - Work within gAIge to update daily tasks assigned on work queue - Log into all hospital applications and insurance carrier portals every two weeks - Submit appeals, correspondence, and medical records via carrier portals - Scan and label correspondence received daily via mail, email, or fax - Navigate hospital applications to obtain balances, charges, and UB documents - Download reports from portals for updates - Assist with the outgoing mail process - Scan documents into database - Assist patients with questions related to statuses of their accounts - Other duties as assigned - Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards - Understand and comply with Information Security and HIPAA policies and procedures at all times - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications - High School Diploma or equivalent - Must be courteous and possess a strong work ethic, with the ability to work in a fast-paced environment - Proficient in Microsoft Office applications - Have strong organization and time-management skills - Ability to learn proprietary databases and systems: gAIge, Epic, Eagle, Epremis, Medi-Tech - Strong interpersonal skills, ability to communicate well at all levels of the organization - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses - High level of integrity and dependability with a strong sense of urgency and results oriented - Excellent written and verbal communication skills required Requirements - Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes Working Conditions - While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear - The employee must be able to follow directions, collaborate with others, and handle stress - The noise level in the work environment is usually minimal Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.