This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves managing the full Medicaid recertification process for residents within supported healthcare facilities. - Manage the full Medicaid recertification process, including tracking timelines and submission deadlines - Review resident files to ensure all documentation meets Medicaid compliance standards - Coordinate with facility staff to obtain required documentation and outstanding information - Prepare and submit recertification documentation accurately and timeously - Communicate with state Medicaid agencies and facility billing departments where required - Maintain accurate and up-to-date records within internal systems - Identify documentation gaps and proactively resolve compliance issues - Ensure recertifications are completed before eligibility expiration to prevent funding disruptions - Provide additional administrative and operational support to facilities as needed Qualifications - Minimum 2+ years’ experience working with medical aid processes within a healthcare, hospital, or long-term care environment - Familiarity with U.S. Medicaid and Medicare processes, eligibility requirements, and compliance documentation is highly beneficial - Experience handling high-volume case files or time-sensitive administrative processes - Strong understanding of compliance-driven environments and regulatory documentation standards - Highly detail-oriented with the ability to manage strict deadlines and multiple resident files simultaneously - Experience working with nursing homes, skilled nursing facilities, or long-term care facilities (advantageous) - Comfortable working within digital systems and maintaining accurate electronic records - Proficient in MS Office and Outlook - Excellent written and verbal English communication skills Requirements - Working Hours: Monday – Friday | 8:00 AM – 5:00 PM EST (2:00 PM – 11:00 PM South African time – subject to daylight savings) - Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA) - Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered - Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered - Work Environment: Fully remote Company Description

• Reviews the appropriate DRG and ICD-10-CM/ PCS coding assignments for accuracy within the coding disputes team from a variety of medical records • Consults and collaborates with coding professionals within and across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality • Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate coding guidelines and communicates disputes outcomes to providers in a professional and concise manner • Leverages advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices • Manages multiple priorities, collaborates with peers and ensures timely completion of inpatient coding disputes

• Act as the primary mortgage audit SME during onboarding, pilots, and go-live phases. • Conduct end-to-end QC validation across income, assets, credit, appraisal, compliance, and closing documentation. • Present audit findings clearly to customers and explain system outputs in underwriting language. • Translate underwriting and QC checklists into structured automation workflows. • Work with Product and Engineering to clarify guideline logic, exception handling, and calculation methodologies. • Validate AI-generated audit outputs and flag discrepancies. • Ensure customer work is delivered accurately and within defined SLAs. • Partner with India-based audit and DP teams to ensure consistent interpretation of guidelines. • Identify gaps between customer guidelines and platform behavior. • Support smooth transition from pilot to scaled delivery. • Drive continuous process improvement and feedback loops.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis. - Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements. - Identify coding discrepancies and formulate suggestions for improvement. - Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. - Work with the Office of the CMO and provider leadership to identify and assist providers with coding. - Report findings and recommendations to Compliance Officer or designee, management, and executive leadership. - Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding. - Support compliance policies with government (Medicare & Medicaid) and private payer regulations. - Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines. - Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications. - Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested. - Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments. - Assist Director of Compliance with incidents and investigations involving coding and/or documentation. - Work closely with all other Compliance personnel to provide coding/compliance support. - Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates. - Provide training to billing coding staff on coding compliance. - Participate in special projects and perform other duties as assigned. Qualifications - High school diploma or equivalent. - 5 years of healthcare experience. - 4 years of procedural and diagnostic coding. Requirements - AAPC Certified Professional Coder (CPC) certification OR Certified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA) upon hire. Knowledge/Skills/Abilities - Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims. - Knowledge in correct application of SNOMED, SNODENT, and LOINC. - Knowledge of medical terminology, disease processes, and pharmacology. - Strong attention to detail and accuracy. - Excellent verbal, written, and communication skills. - Excellent organizational skills. - Ability to multi‐task. - Proficient in Microsoft Office Suite. - Critical thinking/problem solving. - Ability to provide data and recommend process improvement practices.