Med-Metrix

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites • Review and updates all patient and financial information accurately as given • Verify that information is accurate as to individual or insurance company responsible for payment of bill • Monitor all billings for accuracy, updating any that contain known errors • Monitor Medicaid/healthy options coupons to assure services are billed within expected timeframes • Bill all hospital services to primary insurer or patient correctly and within expected timeframe • Follow up with insurance companies on all assigned accounts within expected timeframe • Explain hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts • Identify and report underpayments and denial trends • Analyze, identify and resolve issues causing payer payment delays; Initiate appeals when necessary • Manipulate excel spreadsheets and communicate results • Meet and maintain daily productivity and quality standards established in departmental policies • Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients • Perform special projects and other duties as needed by the management team • Maintain confidentiality at all times • Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• 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

• 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

• Implement all aspects of an application design - high performance design, coding, caching mechanisms, security, encryption, state management, error logging, debugging, scalability, code reviews, development environment configuration, and testing • Develop framework and process for applications project using existing technologies that is implemented in a structured, maintainable fashion • Develop efficient Stored Procedure, queries in MS SQL • Evaluate and Improve application performance • Responsible for coordination, requirements derivation, software design, and implementation of projects • Work primarily in deployment and development solutions team with a focus on delivering for improving experience of customer and development • Perform unit and system level testing on applications • Work closely with product development teams, product management, design office, services, and helps in upgrade testing, analyzing and resolving upgrade issues • Attend to customer escalations • Develop automation tools, utilities and scripts • 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

• Collaborate to define, design, and ship new features in a production application • Improve existing functionality and performance • Implement all aspects of application design, from initial concepts to deployment • Write TypeScript, HTML, and SCSS utilizing Angular and rxjs • Write more TypeScript utilizing Node.js which powers serverless architecture on AWS • Design and implement APIs utilizing serverless REST APIs and WebSocket services • Manage infrastructure through cdk and CloudFormation • Manage and improve continuous integration and delivery • Perform functional testing for work in a local development environment • Write unit tests and integration tests • Monitor new features post deployment using Sentry • Collaborate closely with product management to understand and build out requirements • Collaborate with software engineering team on new features, resolve issues, and knowledge share

• Manage a continuous and high volume of in-bound and out-bound calls from patients, health systems, and insurance carriers, while simultaneously navigating and updating numerous systems, to resolve patient accounts inquiries and collect payment • Attain payment of outstanding patient accounts through use of effective negotiation and customer service skills • Accurately records status of collection efforts in company and member systems • Research alternate insurance or payment options from various client resources available while navigating and updating multiple patient accounting systems. • Assess caller status to ensure the protection of patient privacy and compliance with State and Federal guidelines • Responsible for meeting monthly goals and quality standards through efficient and accurate work processes • 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

• Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion • Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management • Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable • Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care • Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment • Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested • Meets production standards within established time requirements. Work product and performance meets quality standards • Achieve performance goals as outlined in employment agreement • Maintains confidentiality of patient care and business matters • Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role • Demonstrates commitment to meeting/exceeding strategic initiatives of organization • Upholds the organization’s values of team work and professionalism and applies Code of Conduct standards to all members of the healthcare team • Facilitate, mentor, and educate other physicians regarding payer requirements • Attends all meetings as requested by PAOC leadership • Participate in the peer review process as may be necessary or requested • Maintain medical licensure and board certification in good standing • Manages client relationships for PAOC, directing quarterly report creation and JOCs (in concert with the Director of Operations), achieving customer satisfaction and retention • Contributes to execution of PAOC’s Quality program and continuous PA development • Provides education to client facilities’ staff on a variety of relevant topics • Mentors and trains new Physician Advisors as well as existing Physician Advisors to ensure the highest possible consistency and quality for PAOC determinations • Serves as Team Lead for Physician Advisors for Dashboard management as scheduled • Fulfills additional duties as needed within the Physician Advisor II role • Other duties as assigned

• Monitor and respond to employee inquiries related to HR topics, HR policies, and HRIS system navigation • Update employee records in the HRIS system, maintaining data integrity and accuracy as well as ensuring confidentiality • Provide day-to-day coaching to leadership on a variety of actions to include employee relations issues, conflict resolution, policy interpretation and application; talent management and development • Maintain and update employee records and HR files with accurate, timely, and confidential documentation on employee relations cases, in compliance with internal policies and legal requirements • Research and analyze employee trends to understand ways to increase employee retention and engagement. • Maintain a comprehensive understanding of current legal standards, including federal, state, and local employment laws, regulations, and best practices, ensuring compliance and minimize risk associated with daily employee management • Develop in-depth understanding of the company’s products and services, structure, roles, compensation/promotion/disciplinary practices, and HR processes • Analyzes trends, metrics and reports in partnership with HR peers to develop solutions, programs and policies and make recommendations. Utilize Excel (VLOOKUP, Pivot tables, charts & graphs) to collect, organize and summarize data • Process documentation and prepares reports relating to employee activities (training, performance evaluations, employee changes, and terminations) • Conduct analysis of reports and data and use information to create and present information to leadership • Actively participate in the development and implementation of Human Resources policies and procedures • Actively participate in Learning and Development initiatives and programs • Actively participate in the introductory and annual performance review process • Actively participate with government reporting requirements • Complete timely and accurate responses to unemployment claims, ensuring accuracy and adherence to 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

• 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

• The Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. • The Physician Advisor works closely with the Client’s medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients. • This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities. • Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion. • Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management. • Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable. • Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care. • Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment. • Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested. • Meets productivity and quality standards within established time requirements. Work product and performance meets or exceeds quality standards. • Achieve performance goals as outlined in employment agreement. • Maintains confidentiality of patient care and business matters. • Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role. • Demonstrates commitment to meeting/exceeding strategic initiatives of organization. • Upholds the organization’s values of teamwork and professionalism and applies Code of Conduct standards to all members of the healthcare team. • Facilitate, mentor, and educate other physicians regarding payer requirements. • Attends all meetings as requested by PAOC leadership. • Participate in the peer review process as may be necessary or requested. • Maintain medical licensure and board certification in good standing. • During scheduled work hours, commits full attention to Physician Advisory and execution of outlined tasks. • Other duties as assigned.