Role Description The Senior Consultant provides a wide range of healthcare consulting services to various providers, hospitals, health systems, academic medical centers, and health plans. Works collaboratively within the organization and division levels to assist on projects compatible with knowledge, skills, and abilities. Demonstrates expertise in multi-specialty/multi-faceted engagements. Monitors progress of other resources to assist meeting deadlines. Ability to work closely with Managing Consultant to help with client engagements and support resources. This position will work closely with several team members and staff of affiliated companies of Pinnacle Healthcare Consulting for the financial health and growth of overall business. Demonstrates expertise serving in a consultant role. Qualifications - College degree. - Certification in at least one (1) area of healthcare business is required (i.e., AAPC®, AHIMA®, HFMA, HCCA) with at least two (2) credentials. Requirements - Minimum of 3+ years of healthcare industry experience in a healthcare consulting company and/or provider organization required. - Multi-faceted subject matter expertise in healthcare billing/coding and/or compliance for a minimum of 2 years. - Knowledge of healthcare technology solutions, such as: Electronic Medical Record, Enterprise Resource Management, or Patient Financial Services systems. - Expanded knowledge of OIG Work Plans, CMS Guidelines, HIPAA, and AHIMA/AAPC standards. - Successfully participate in multiple and rapidly changing projects effectively. - Handle confidential information with discretion and adapt to competing demands. - Think strategically, solve problems and propose solutions. - Work under tight deadlines and manage multiple priorities. - Achieve high performance goals and meet deadlines in a fast-paced environment. Benefits - Position is remote with possible travel up to 10%. - The job may require occasional evening and weekend work to meet project demands, company promotional event support, and team logistic needs. Company Description Pinnacle Healthcare Consulting is an Equal Opportunity Employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition, or any protected category prohibited by local, state, or federal laws.

Job Description​ Patient Accounts Representative is responsible for reviewing, billing, collection, and accounts receivable activities for the hospital (and in some cases the physician) billing departments within Saint Luke's Health System. Activities include, but are not limited to, entering demographics, troubleshooting issues, responding to inbound and outbound billing calls from patients, payment posting, resolving credits, identifying, and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Patient Account Representative may be responsible for any or all the following duties, including duties not otherwise assigned. Location: This position is a work from home position, candidate must be located in Kansas or Missouri Schedule: Flexible Schedule - Monday - Friday: 6:00AM - 6:00PM Claim Processing Responsible for researching patient billing claims to correct claim errors Understand respective payor requirements so claims are processed correctly Familiar with NCCI / NCD / LCD edits, incidentals/inclusive, and bundling rules, etc. Work with multiple teams/departments to resolve issues Hand billing of specialty care which may include residential care, transplant and research Insurance Denials Responsible for researching, identifying errors, and correcting claims denied by insurance companies. Responsible for writing appeal letters to insurance companies Research refund request from payor organizations Responsible for preliminary audit of billing code errors before claim resubmitted from denial Responsible for becoming a subject matter expert on the payor policies Payment posting corrections/adjustments and ability to distribute payments Insurance Follow-Up Responsible for following up with insurance companies for unpaid claims Responsible for communicating and resolving problems with the provider representatives when applicable Payment posting corrections/adjustments and ability to distribute payments Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage claim rejection/no pays Client Accounts Responsible for reviewing all accounts at the beginning of the month to make sure they are ready for statements. Work with clients on any billing questions they have Client refunds Job Requirements Applicable Experience: 1 year Diploma Job Details Full Time Day (United States of America) The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter. Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.

About Us Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. - Come Join Our Team! - As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards. - Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary - The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution. Essential Functions and Tasks - Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques. - Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides. - Validate denial reasons and ensures coding is accurate. - Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. - Follow specific payer guidelines for appeals submission. - Escalate exhausted appeal efforts for resolution. - Adhere to departmental production and quality standards. - Complete special projects as assigned by management. - Maintain working knowledge of workflow, systems, and tools used in the department. Education and Experience Requirements - High school diploma or equivalent. - One to three years’ experience in physician medical billing with emphasis on research and claim denials. - Current AAPC or AHIMA certification required. Knowledge, Skills, and Abilities - Knowledge of health insurance, including coding. - Thorough knowledge of physician billing policies and procedures. - Thorough knowledge of healthcare reimbursement guidelines. - Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. - Computer literate, working knowledge of Excel helpful. - Able to work in a fast-paced environment. - Good organizational and analytical skills. - Ability to work independently. - Ability to communicate effectively and efficiently.Proficient computer skills, with the ability to learn applicable internal systems.Ability to work collaboratively with others toward the accomplishment of shared goals. - Basic use of computer, telephone, internet, copier, fax, and scanner. - Basic touch 10 key skills. - Basic Math skills. - Understand and comply with company policies and procedures. - Strong oral, written, and interpersonal communication skills. - Strong time management and organizational skills. - Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills. Compensation - Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. - This position is also eligible for a discretionary incentive bonus in accordance with company policies. Ventra Health Equal Employment Opportunity (Applicable only in the US)Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment AgenciesVentra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of PaymentVentra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention CandidatesPlease be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. Statement of AccessibilityVentra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Coding Specialists are an important part of the Team at CorroHealth. The Coding Team Member will provide CPT, HCPCS and ICD-10-CM coding a minimum of 1-4 specialties. Will be Coding Professional Fee, Facility, or HCC. Professional Fee Specialties could include UR, Podiatry, Plastics, Pediatrics, OB, Pain Management, Ortho, Addiction, General Surgery, Internal Medicine, Urgent Care, Pulmonary, or ED. Facility Chart types could include OT, PT, Urgent Care, ED, or a variety of other specialties. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. - Team Member must be able to work from home and be independent in their coding skills. - Provide various components of coding services to support our clients. - Code outpatient same day surgical CPT procedures for multiple specialties ranging in the 10000-69999 range of codes and occasionally in 9XXXX range. - Apply ICD-10-CM diagnosis codes to the highest level of specificity available. - Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS - Interpret coding guidelines for accurate code assignment - Identify the importance of documentation on code assignment and the subsequent reimbursement impact. - Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program. - Comply with all internal policies and procedures. - Actively participate in Company provided training and education. - All Coders must maintain at least one credential through either AAPC or AHIMA. - Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information MINIMUM QUALIFICATIONS & REQUIREMENTS: - All coders MUST be certified through either the AAPC (CPC or COC) or AHIMA (CCS or CCS-P). - Must have at least a minimum of 6 months of on the job experience. - Regular, predictable, and punctual attendance is required. - Must have working knowledge and experience with systems such as EMR, Billing, etc - Must have a phone, reliable internet connection and current coding materials such as CPT and ICD-10-CM coding references. - Will be required to maintain an ongoing productivity level and accuracy rate of 95% or higher - Will be required to maintain a quality score of 95% or higher - Must be proficient in Microsoft programs like Excel and Outlook. Examples include: - Excel you should be able to open and add to a spreadsheet, perform basic formulas like adding or multiplying. - Outlooks you should be able to manage emails and schedule and attend meetings. - Ability to communicate effectively and professionally both verbally and written. - Ability to coordinate, analyze, observe, make decisions, and meet deadlines - May be required to perform other duties as assigned by Leadership Team Member. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.