• Performs ongoing analysis of medical record documentation and codes assigned per CMS, CPT, and Ventra Health documentation guidelines. • Assign appropriate ICD-10-CM and CPT codes and modifiers according to documentation. • Perform MIPS review as needed. • Perform Provider QA as needed. • Document coding errors. • Assist coding management. • Assist with client/provider audits as needed. • Assist with reviewing work product of new coders in training, as needed. • Provides feedback to coders on coding discrepancies/deficiencies, as needed. • Maintains confidentiality for all personal, financial, and medical information found in medical records per HIPAA guidelines and Ventra Health policy.

• Reviews the documentation in the record to identify all pertinent facts necessary to select comprehensive diagnoses and procedures • Codes evaluation and management to appropriate CPT code and codes diagnosis to appropriate ICD-10 code • Meets with physicians to review documentation, resolve coding and secure signatures • Acts as lead person and assists coders with IBC staff with medical terminology and policy interpretation as required • Assists with efforts to increase physician awareness of documentation requirements • Prepares case reports and initiates follow-up for billing process

• Works in collaboration with physicians • Review medical record to abstract proper code assignment • Assign ICD-10 CM/PCS codes to outpatient, emergency room, and professional services • Responsible for reporting any safety-related incidents

Role Description The Claims Billing Specialist I reviews and processes billing inquiries and medical bills, ensuring accuracy and compliance with company policies, regulations, and HIPAA. The Specialist works with providers, vendors, and internal teams to resolve discrepancies, collect documentation, and assist with payment and penalty calculations. Under close supervision, the Specialist manages routine inquiries, escalates complex issues, and helps maintain efficient, accurate billing, payment, and claims operations. The position requires attention to detail, clear communication, and a commitment to professionalism, confidentiality, and ethical conduct. Essential Duties and Responsibilities - Conduct business at all times with the highest standards of personal, professional, and ethical conduct. - Research and process provider billing inquiries, identifying discrepancies and applying standard resolution steps. - Review, calculate, then process in-house payments. - Review medical bills and accurately complete claims management system work items and assigned tasks. - Communicate with providers and internal staff to gather required documentation. - Review and respond to incoming mail, emails, telephone calls, and fax transmissions. - Maintain accurate documentation in claims systems. - Ensure all billing activities comply with company policies, regulatory requirements, and applicable standards (including HIPAA). - Adhere to turnaround time parameters established by company policies and procedures. - Maintain confidentiality of all data and records in accordance with HIPAA and state regulations. - Participate in training to build knowledge of workers’ compensation billing and payment practices. - Perform special projects as assigned. - Other duties as assigned. Qualifications - 1 - 3 years of experience in workers comp claims or medical billing. - Demonstrated skill in working independently within role responsibility while demonstrating multitasking skills. - Excellent communication skills fostering a responsive customer service environment. - Excellent time management and organizational skills. - Ability to understand statutes, regulations and company policies and procedures. - Must be detail-oriented with demonstrated ability to handle multiple tasks simultaneously. - Ability to demonstrate initiative and to meet designated deadlines. - Proficiency in MS Office Suite (Word, Excel, Outlook) and other relevant software tools. - Proven ability to handle sensitive and confidential information with discretion and professionalism. - Equivalent combinations of education and experience may be considered. Requirements - Must have High School diploma or equivalent. - Some college preferred with experience and/or training in data management and paper media production. Working Conditions - Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship. - It requires a suitable space that provides a private and quiet workplace. - Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. - Travel: May be required to travel to off-site location(s) to attend meetings, as necessary. Hourly Pay Rate $22.00 per hour and a comprehensive benefits package, please follow the link to our benefits page for details! Benefits - Dynamic, fast-growing provider of workers' compensation insurance and services. - Positive, challenging work environment. - Opportunity to build your career while helping grow the business. - Core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. - Energetic environment that inspires top achievement.