This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Medical Assistant, your role is to support the clinical team of RNs, NPs, PAs, and MDs in providing excellent member care through direct education, counseling, and clinical care to members. What You’ll Do: - Manage incoming messages in our message center (Zendesk); route messages to appropriate recipients and answer questions as allowed by scope of practice - Ensure timely follow-up on messages in your personal queue - Contact pharmacies either proactively or by returning pharmacy voicemails with questions regarding prescriptions - Code and fill out insurance forms; manage a queue of prior authorization requests - Prep clinical charts ahead of member appointments - Follow up on issues with member IDs and addresses, missing documentation, past due account status, and lab location issues - Review PHQ/GAD surveys and follow up with members with high PHQ scores - Proactively reach out to members scheduling ADHD appointments to verify documentation - Prep replacement medication orders for meds that fail internal checks - Update and fill out patient medical records, including documenting medical history - Arrange lab services and communicate with labs to retrieve results when necessary - Collaborate across teams on clinical and operational workflows - Complete any forms or paperwork deemed necessary by members, schools, or healthcare entities - Support and participate in Quality Assurance activities - Create member education materials (library articles, short FAQ, etc) - Learn new tools as needed to help deliver ongoing value to members - Complete other duties as assigned - Maintenance of active MA certification Qualifications - Clinical experience and expertise serving the trans and queer communities - Ability to communicate clearly and compassionately with a wide variety of patients and coworkers - Dedication to the FOLX mission and Informed Consent model of care--where radical transparency, collaboration, and empowerment of the individual are of utmost priority - Desire to ensure all questions from a patient are answered completely, and patient is linked with appropriate resources and referrals if beyond our scope - Excellent decision-making skills and communication - Great organizational and time management skills that allow for timely completion of tasks and patient follow-up, especially important in a remote work environment - Demonstrated experience in working with diverse groups, including diversity in race, ethnicity, economic status, and educational background. Requirements - Active MA certification (through the American Association of Medical Assistants preferred) Benefits - Salary: $60,000 (please note that this position is non-exempt for California residents) Company Description We are proud to be an equal opportunity employer, and do not discriminate on the basis of race, color, ethnicity, national origin, religious affiliation, sex, gender identity, sexual orientation, disability, or any other legally protected status. Here, diversity and inclusion means accepting that everyone’s perspective can teach you something. We’re eager to learn. Please note: There has been a recent increase in employment scams. FOLX posts all of our open positions on our careers page at www.folxhealth.com/careers and only contacts candidates from official "@folxhealth.com" email addresses.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines. - Conduct audits (i.e. baseline, routine periodic, and focused) comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes with consideration of applicable federal and state laws, regulations, and guidelines. - Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare. - Acts as an internal expert on coding issues to ensure compliance with state and federal regulations. - Preparation of audit reports including summary of findings. - Conduct post-audit provider education with individual or large provider groups. - Schedule trainings with provider’s offices, individual providers and groups of providers. - Provides feedback, initial and ongoing education and training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision, timely submission, healthcare data accuracy, and coding principles. - Communicates audit findings to providers to track education completion and escalation. - Interacts professionally and effectively with physicians, leaders, staff, and internal teams. - Provides coding assessment, consultation, education, and issue resolution to key stakeholders as requested. - Able to have honest, difficult conversations with providers about compliance, documentation, and code assignment. - Other duties as assigned. Qualifications - 5+ years of audit and provider education experience is preferred. - Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines. - Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required. - Experience working with MDAudit and Athena is a plus. - Must comply with all HIPAA rules and regulations. - Excellent communication skills and the ability to work independently. Requirements - The salary range for this role is $70,000.00 to $80,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). - This role is also eligible for an annual bonus targeted at 15%. - The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. Benefits - All your information will be kept confidential according to EEO guidelines. - Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Welcome to Ovation Healthcare! At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions. The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior. We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork. Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com. Summary: Ovation Healthcare is seeking a billing specialist. The Billing Specialist is responsible for managing the daily billing and ensuring timely accurate clean claims, claim reviews and resolves billing daily claim edits and ensuring compliance with Insurance billing policies and regulations. Duties and Responsibilities: - Extensive understanding of billing guidelines for UB/1500 claims and a deep understanding of each claim field requirement. - Maintain a list of split billing requirements by payer and add to the team crosswalk and keep abreast of any payer changes. The billing specialist should be well versed in Payer portal appeal uploads and assist with providing the internal team feedback when necessary. - Import claims from host system into claims processing system when required. Review claims that are pended for edits and resolve. - Prepare and submit accurate claims for patient services, ensuring compliance with third party payer guidelines and regulations. - Review patient accounts and reconcile payments with secondary payers and review remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed before filing the secondary payer. - Ensure all billing and collection practices are compliant with CMS regulations, HIPAA, and company policies. Maintain accurate records of all claims and ensure proper documentation in the patient account system. - Meet daily productivity and quality standards as assigned. - Work with internal departments, such as patient financial services, finance, and billing, to address any issues or disputes affecting patient accounts. - Assist management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows. Knowledge, Skills, and Abilities: - Proven experience in third party insurance billing, collections, or patient accounts, preferably in a healthcare setting. - In-depth knowledge of billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively. - Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations. - Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously. - Problem-solving abilities, particularly regarding billing discrepancies and denied claims.

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Overview The Physician Coding Denials Specialist is responsible for reviewing and appealing coding denials for all assigned professional service claims related to Evaluation and Management coding. Closely works with Charge Coding & Revenue Management leaders and Account Resolution teams to provide feedback to providers/practices to improve clinical documentation and facilitate ongoing documentation improvement. Responsible for performing appeals for the Wellstar MGBO for professional services as deemed necessary. Monitor's denial work queues within Epic (Electronic Health Record) to ensure timely appeal deadlines are met. Must ensure timely, accurate and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain root cause of denials. Uses analytical skills to identify trends in payer denials and translates this information into Charge Review edits that will be used to prevent future denials. Assists in development and implementation of training for charge capture specialists. Responsibilities Core Responsibilites and Essential Functions - Coding Denials Management * Identify major reasons for denials root causes (Diagnosis, procedure codes, etc.) * Work collaboratively with charge coding and revenue management to provide coding and documentation feedback to practices/providers. * Utilize Epic to review account denial audits and perform trend analyses to identify patterns and variations in coding denials and practices. * Maintain open communication with Wellstar Medical Group providers and practices to facilitate denial/appeals process. * Review clinical records to identify overcharges, undercharges or charges that necessitate additional documentation. * Research and analyze charge and coding requirements for new services and technology. * Consistently meet current productivity and quality standards as assigned by department manager in ensuring accurate account follow-up. - Analysis and Interpretation of Trends * Identify opportunities for system and process improvement and submit to management. * Working with MGBO Edit Committee, physician coding compliance and Epic Connect, translate identified trends into Epic charge review rules. * Evaluates and adheres to clinical and billing policies, guidelines, and regulations of both commercial and governmental payors. * Appeals denials or instructs the resubmission of claims based on compliant medical record documentation and Wellstar Medical Group/MGBO policies and procedures. * Asses need for formal appeals of all clinical denials including but not limited to preauthorization of practice encounters and procedures, and for retroactive recovery reviews regarding medical necessity and limited billing compliance. - Professional Communication * Communicate with all internal contacts in a professional manner including providers, practice staff, co-workers, management, and clinical staff. * Communicate with all external contacts in a professional manner including representatives from third party payor organizations. * Interact with internal customers/departments including HIM, Charge Coding and Revenue Management, Patient Access and the Single Business Office in a professional manner to achieve revenue cycle department accounts receivable goals and objectives. * Assure patient privacy and confidentiality as appropriate or required. * Initiate communication with peers about changes in payor policies and internal policies and procedures. * Prepare appeal letters that are specific, concise, and conclusive; providing payors with appropriate clinical documentation as needed. * Provide feedback to physicians, providers and management in a timely and professional manner. - Department Methods, Procedures and Operations * Follow department guidelines for lunch, breaks, requesting time off, and shift assignments. * Demonstrate knowledge of the health system HIPAA privacy standards and ensure compliance with system PHI privacy practices. * Follow the health system’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures. * Follow JCAHO and outside regulatory agencies’ mandated rules and procedures. * Participate in the testing for assigned software applications, including verification of field integrity. * Perform other duties and responsibilities as assigned. Required for All Jobs - Performs other duties as assigned - Complies with all Wellstar Health System policies, standards of work, and code of conduct. Qualifications Required Minimum Education - High school diploma or equivalent Required - AAPC or AHIMA professional coding certification required Required or - >5 years of experience is acceptable with a professional certification within 90 days of employment Required or - If enrolled in a coding program within 90 days of graduation. Proof of enrollment required. Required Minimum Experience - Minimum 2 years of Healthcare Account Resolution experience or Physician billing experience, including professional coding experience. Required Required Minimum Skills - High level problem solving, analytical and investigational skills to research and resolve denied accounts. - Technical skills to include Microsoft Office (Word, Excel, PowerPoint, Teams), EMR systems (Epic), graphs and tables experience and personal computers. Strong time management skills to independently manage multiple priorities and a heavy workload. - Demonstrated flexibility to perform other tasks as needed in an active work environment with changing work needs. - Ability to prioritize assignments to meet deadlines. - Proven communication skills and positive motivational skills. - Medical terminology and or anatomy/physiology, ICD-10, and E/M coding. Understand governmental and commercial payor compliance regulations. Required Minimum License(s) and Certification(s) - Cert Prof Coder Preferred Additional Licenses and Certifications - AAPC or AHIMA professional coding certification Required - CPB Preferred Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.