• Serve as the internal and external Subject Matter Expert (SME) on medical coding and billing across assigned service lines. • Review and validate model-generated CPT, ICD-10-CM, HCPCS, and E&M codes • Perform high-quality coding and auditing on inpatient, outpatient, ED, or pro-fee encounters (depending on specialty) • Ensure documentation fully supports coding decisions in alignment with AMA, CMS, and payer guidelines • Identify missed codes, incorrect E/M leveling, modifier errors, and insufficient documentation • Analyze and document customers’ coding practices and workflows to facilitate optimal use of the CodaMetrix product. • Identify and share Codametrix’s best practices for coding automation and workflow improvements with the customer. • Present audit results to customer stakeholders and facilitate sign-off for go-live milestones. • Assist manager with Coding Quality Assessment (CQA) projects, including work assignments, training, and quality assurance for offshore coding staff. • Leverage CodaMetrix coding standards to drive world-class coding quality and consistency. • Work with product and engineering to provide precise, consistent feedback on model training and data annotation • Continuously improve evaluation and training materials on coding and billing to colleagues and customers. • Share knowledge throughout CodaMetrix to build internal competencies and champion continuous improvement initiatives. • Provide expert guidance on coding and billing questions to support Machine Learning and Product teams. • Proactively stay up to date with changes in medical coding and billing by maintaining relevant certifications and participating in ongoing education. • Uphold all legal and ethical requirements, ensuring accuracy, confidentiality, and compliance in all coding and audit activities. • Help explain model decisions, error analyses, and coding rationales to clients • Support customer success and implementation teams in understanding coding outputs • Prepare clear written summaries of coding patterns, documentation issues, or model behavior • Collaborate with cross-functional teams—such as Data Science, Product, and Customer Success—to address client needs and optimize results.

Overview MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS consulting group. The role of the Remote MDS Coordinator is to work with our contract partners to plan, organize, and coordinate the completion of the Minimum Data Set (MDS) in accordance with current Federal and State Regulations. If you are looking for something that is flexible and collaborative, come join us! We thrive on Quality Resident Care. What do we offer you? - Creative, fun, and flexible working environment - The following benefits: - Competitive salaries and bonuses. - Comprehensive health and life insurance. - 401K with discretionary match - Mileage and licensure reimbursements. - Flexible Spending Account and HSA - Reasonable working hours. - CE opportunities. - Paid sick, holiday, and vacation leave. - Promotion/Transfer/Advancement opportunities. - Meaningful work and job satisfaction. Responsibilities - MDS scheduling and coordinating to ensure timeliness of assigned sections of MDS per RAI guidelines, including coordinating care plan development and completion with the interdisciplinary team. - Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. - Develop an individualized, comprehensive resident care plan in collaboration with the interdisciplinary team to ensure care area triggers are addressed. - Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions. - Review and verify MDS documentation and charting requirements to support the clinical services provided for each resident. - Ensure timely submission of all Minimum Data Sets to the state data base and ensures that the necessary follow-up action is taken. - Promote highest degree of quality care through QI/QM data with facility team and identify trends to assist facility in advancing facility processes, improve resident outcomes, and optimize reimbursement. Qualifications - Nursing Experience in MDS Assessment: 3+ year - RAC-CT preferred - RN or LPN - Thorough understanding of PDPM requirements - Able to negotiate through EMR and possess strong computer skills - Promotes and demonstrates excellence in customer service

Become a part of our caring community and help us put health first The Specialty Operations Pharmacy Technician 2 supports Pharmacists in Specialty Rx medication preparation by dispensing Specialty Rx medications. The Specialty Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Specialty Operations Pharmacy Technician 2 May contact physicians for prescriptions clarification and may enter prescription orders into the system. Also supports Pharmacists and Patients by ensuring adherence to Specialty Rx specific operational processes and programs developed to optimize health outcomes which includes effective communication with patients and providers. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, andworks under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. Use your skills to make an impact Required Qualifications Must have an active license with the Board of Pharmacy in the appropriate state. Certified Pharmacy Technician. Schedule: Monday-Friday: 8 AM-4:30 PM EST Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $40,000 - $52,300 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

• Examines medical records to determine the proper ICD and CPT codes to be assigned • Utilizes coding tools & resources to verify the correctness of CPT and ICD codes assigned • Abstracts data including providers, injury info, quality measures, and others as needed • Maintains knowledge of current trends and practices in coding principles and government regulations • Communicates with coworkers and physicians to resolve and clarify questions and documentation discrepancies • Participates in coder specific training and education based on audit metrics and trends