Role Description The QA Specialist plays a critical role in ensuring the accuracy, compliance, and quality of all Medicare and Medicaid claims before submission. In this high‑volume, detail‑driven position, the QA Specialist reviews patient care reports (PCRs), validates service levels and documentation, and confirms that all regulatory and payer‑specific requirements are met. This role requires clinical insight, exceptional attention to detail, and a commitment to maintaining the highest standards of billing integrity. Essential Duties and Responsibilities - Perform detailed quality reviews of all Medicare/Medicaid claims after coding and before submission to ensure accuracy, compliance, and completeness. - Examine patient care reports (PCRs) to confirm documentation supports the billed level of service and adheres to payer rules and medical necessity standards. - Validate coding selections, including level of service assignments, mileage accuracy, and required clinical indicators. - Ensure documentation compliance with federal, state, and payer regulations, including signature requirements, narratives, interventions, and supporting details. - Verify claim readiness by ensuring all required documentation and attachments are present prior to releasing the claim. - Identify discrepancies or errors and take action to correct, escalate, or return claims to coders for further review. - Maintain high‑volume throughput while consistently meeting accuracy and productivity expectations. - Collaborate with Coding, Billing, QA leadership, and other internal teams to resolve questions or clarify documentation issues. - Support continuous quality improvement by identifying trends, gaps, or training opportunities. - Additional job duties as assigned. Qualifications - Education: High School Diploma or equivalent. - Clinical or medical background strongly preferred: LPN, RN, EMT, Paramedic, LNA, Medical Aide, or equivalent experience. - Strong understanding of medical terminology, EMS clinical documentation, and healthcare billing standards. - Ability to navigate and work efficiently across multiple computer programs simultaneously. - Must have reliable home internet with speeds of 15 Mbps or higher. - Must successfully complete a basic computer skills assessment prior to interview; typing test for speed and accuracy may also be required. - Excellent attention to detail, accuracy, and documentation review skills. - Strong time‑management skills with the ability to meet tight deadlines and maintain high productivity. - Ability to remain focused, organized, and productive in a remote, independent work environment. - Strong communication skills, both written and verbal, with professionalism and excellent judgment. - Dependable, punctual, and comfortable asking questions or seeking clarification when needed. - Ability to remain calm and effective in a fast-paced, time‑sensitive workload environment. - Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment. Physical Requirements - Ability to talk, hear, and see clearly to read and interpret information. - Regular use of a computer, phone, and standard office equipment. - May be required to travel for business purposes. - Ability to secure confidential information. - Perform all duties in a professional environment free of noise or anything that would create a negative customer experience. Benefits - Competitive salary, commensurate with experience. - Comprehensive benefits package, including 401(k) Plan.

Role Description Digitech is seeking a highly motivated and detail‑oriented Insurance Account Resolution Specialist to manage and resolve insurance claims after submission to commercial insurance carriers. This role is responsible for ensuring timely, accurate, and compliant claim resolution by reviewing pending, denied, or incorrectly paid claims and following through until payment is secured. Success in this role requires strong analytical skills, excellent follow‑through, and the ability to manage a high‑volume workload in a fast‑paced environment. - Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by commercial insurance carriers. - Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow‑up actions to release claims for processing. - Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmissions. - Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims. - Prepare and submit additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing. - Draft and submit appeals when necessary, ensuring they are supported by proper documentation, regulatory guidelines, and payer‑specific requirements. - Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds. - Maintain accurate, detailed notes in billing systems for all follow‑up activities, findings, and next steps. - Identify trends or recurring issues, escalating concerns to supervisors or appropriate internal teams to support process improvement. - Meet daily productivity and accuracy expectations, contributing to a high‑performing team environment. - Additional job duties as assigned. Qualifications - Education: High School Diploma or equivalent required. - Strong computer skills, including working knowledge of MS Outlook, Word, and Excel. - Ability to type 40 WPM with accuracy. - Proven ability to handle high‑volume workloads, prioritize effectively, and meet tight deadlines. - Experience in a structured environment where call monitoring, performance metrics, or productivity scoring are used is helpful. - Strong verbal communication skills with the ability to remain calm, professional, and effective during phone interactions with insurance carriers. - Excellent written communication skills for crafting clear, accurate documentation and correspondence. - Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings. - Highly organized, self‑paced, and capable of managing work independently in a remote environment. - Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when needed. - Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment. Requirements - Ability to talk, hear, and see clearly to read and interpret information. - Regular use of a computer, phone, and standard office equipment. - May be required to travel for business purposes. - Ability to secure confidential information. - Perform all duties in a professional environment free of noise or anything that would create a negative customer experience. Benefits - Competitive salary, commensurate with experience. - Comprehensive benefits package, including 401(k) Plan.

• Review medical records to abstract ICD-10 codes, specifically those that map to HCCs, RxHCCs, and ESRD models • Coders will follow Medicare guidelines, ICD-10-CM guidelines as well as client specific requirements

• Review medical records to abstract ICD-10 codes, specifically those that map to HCCs, RxHCCs, and ESRD models. • Follow Medicare guidelines, ICD-10-CM guidelines as well as client specific requirements.