Mountain Management Services

Role Description As our Auditor, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility. Every day, you will conduct comprehensive audits of financial records, processes, and regulatory compliance. You’ll identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws, directly supporting sound decision-making. To be successful, you’ll combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations, sharp attention to detail, and the ability to communicate complex findings persuasively, transforming audit insights into tangible improvements. - Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate the accurate reporting of HCC diagnoses via claims. - Works to resolve claims denials and reports denial trends to leadership. - Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patients’ chart note. - Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures. - Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process. - Assists in the development and reporting of HCC and Pay for Performance metrics. Qualifications - Five years physician coding experience. - Certified Rehabilitation Counselor, within 12 months. - Certified Professional Coder Hospital Apprentice, upon hire. - Certified Professional Coder Apprentice, upon hire. - Certified Coding Associate, upon hire. - Cardiology Coding, upon hire. - Certified Coding Specialist, upon hire. - Certified Coding Specialist - Physician Based, upon hire. - Certified Cardiovascular and Thoracic Surgery Coder, upon hire. - Certified Health Care Compliance, upon hire. - Certified Interventional Radiology Cardio Coder, upon hire. - Certified Professional Coder, upon hire. - Certified Professional Coder Hospital, upon hire. - Radiology Certified Coder, upon hire. - Registered Health Information Administrator, upon hire. - Registered Health Information Technician, upon hire. Requirements - Associates Other, upon hire. - Three years experience performing diagnosis, E/M, and procedure code audit/review/education functions for professional fees in multi-specialty setting. - Registered Nurse: TN, upon hire. - Licensed Practical Nurse: TN, upon hire. - Certified Nursing Assistant: TN, upon hire. - Certified Professional Medical Auditor, upon hire.

Role Description As an Insurance Follow Up Rep, you will resolve unpaid insurance claims and collect outstanding balances from third-party payers. Every day you will: - Review denials - Initiate follow-up with insurers - Rectify billing errors - Submit appeals - Negotiate for maximum reimbursement To be successful, you will understand billing regulations, possess strong problem-solving skills, and communicate effectively to optimize revenue recovery. - Follow up with insurance payers to research and resolve unpaid insurance accounts receivable; make necessary corrections in the practice management system to ensure appropriate reimbursement is received for all FMG providers. - Apply a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received. - Communicate effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements. - Resubmit claims with necessary information when requested through paper or electronic methods. - Anticipate potential areas of concern within the follow-up function; identify issues/trends and conduct staff training to address and rectify. - Recognize when additional assistance is needed to resolve insurance balances and escalate appropriately and timely through defined communication and escalation channels. Qualifications - High School Graduate or High School GED - Graduation from a post-high school program in medical billing or other business-related field (preferred) - Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities (preferred) Company Description CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

Role Description As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. - Accurately abstracts information from the service documentation, assigns and sequences appropriate CPT, ICD-9/10, and HCPCS codes into the appropriate billing systems, ensuring compliance with established guidelines. - Communicates professionally with providers, practice management, and other stakeholders either verbally or in writing. - Responsible for working encounters in the coding work queue or task lists in a timely manner. - Meets or exceeds organizational coding production and quality standards. - Understands and applies regulatory changes and stays current with coding updates, for example NCCI and MUE edits. - Reviews and resolves coding denials. Qualifications - High School Diploma or High School GED - Certified Professional Coder - Certified Professional Coder Hospital Apprentice - Certified Professional Coder Apprentice