• Abstract clinical information and assign appropriate diagnosis and procedure codes in accordance with nationally recognized coding guidelines. • Analyze and translate medical and clinical diagnoses, in adherence with the CMS Risk Adjustment Models. • Work as a team with coding team and providers. • Audit patient health assessment, peer coding quality reviews, provider and coding team training and education. • Perform medical chart audits on prospective basis to identify, monitor and document claims and encounter coding information as it relates to Hierarchical Condition Categories (HCC). • Perform coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes and are adhering to CMS Risk Adjustment guidelines. • Educate clinicians on specific coding issues found in their charts and keep them abreast of coding and documentation guidelines. • Maintain 95% coding accuracy rate. • Maintain production goals. • Perform accurate and timely coding (CPT, ICD-9, ICD-10, HCPCS, modifiers). • Demonstrate advanced knowledge of medical terminology, anatomy, and physiology. • Provide timely correspondence with providers regarding clinical documentation opportunities and queries. • Identify trends through data analysis or chart review, reviewing existing policy for accuracy and developing new policies and recommend solutions to meet objectives. • Keep abreast of mandated regulatory, documentation and coding guidelines to documentation, including demonstrated proficiency with all areas of CPT, ICD-10 and HCPCS coding. • E/M code assignment, auditing, and education. • Perform quality audits, education, and training for coding team. • Work closely with leadership to create coding tools for coding team and providers. • Perform other duties as required or assigned.

Role Description We are seeking an experienced, detail-oriented, and analytical Virtual Medical Biller & Revenue Cycle Specialist to take complete ownership of the financial health of a client's growing surgical and aesthetics practice. This role is built for a senior billing professional who understands that specialty surgical billing requires a highly strategic, meticulous approach to maximize reimbursements. You will manage our revenue cycle from end to end—ensuring complex surgical claims are cleanly coded, submitted swiftly, and aggressively followed through to resolution. The ideal candidate brings a proven track record navigating the distinct nuances of bariatric, general, and cosmetic surgery coding, including mastery over both In-Network (INN) and Out-of-Network (OON) commercial billing models. Core Responsibilities - Surgical Coding & High-Accuracy Billing (Primary Focus) - Claim Scrubbing & Submission: Review, scrub, and electronically submit all medical claims timely, ensuring complete compliance with diverse payer policies. - Specialty Coding Verification: Audit clinical documentation to verify the precise accuracy of complex surgical CPT modifiers, ICD-10 codes, and procedural coding combinations. - Pre-Submission Quality Control: Proactively catch and resolve technical billing errors prior to clearinghouse submission to maintain an elite first-pass clean claim rate. - End-to-End Revenue Cycle Management (RCM) - Denial & Appeal Mastery: Actively monitor claim statuses, immediately researching, correcting, and aggressively appealing denied, underpaid, or rejected claims. - A/R Clean Up: Systematically track insurance aging reports and accounts receivable balances to drastically reduce outstanding days in A/R. - Performance Analysis: Identify systemic underpayment patterns or friction points with payers, working proactively to streamline workflows and boost overall collections. - Front-End Alignment & Support - Advanced Benefits Verification: Audit intricate in-network and out-of-network patient insurance profiles, confirming deductibles, coinsurance splits, and specialized surgical caps. - Authorization & Referral Auditing: Cross-verify that required pre-authorizations and physician referrals are perfectly mapped to the patient's chart and match the scheduled surgical CPT codes. - Payer & Patient Relations - Insurance Discrepancy Resolution: Maintain assertive, highly professional communication with commercial insurance carriers and Medicare to resolve complex claim bottlenecks. - Financial Counseling Support: Clearly and compassionately explain billing statements, insurance allocations, and balances to patients when escalated billing inquiries arise. Qualifications - Biller Credentials: Minimum 2+ years of dedicated U.S. medical billing experience, with a heavy emphasis on full-cycle revenue management. - Surgical Billing Acumen: Proven experience working inside a surgical or specialty medical practice; comfortable with multi-tier surgical coding rules. - Insurance Ecosystem Fluency: Deep understanding of the operational differences between In-Network and Out-of-Network insurance models, commercial payers, and Medicare. - Technical Workspace: Dedicated, highly secure home office setup compliant with HIPAA privacy protocols, equipped with high-speed internet and a dual-monitor environment (preferred). Strongly Preferred Experience - Direct, hands-on billing experience for Bariatric Surgery, General Surgery, or Medical Aesthetics. - Advanced technical fluency within the Practice Fusion EMR ecosystem. - Deep knowledge of surgical bundling, multiple procedure modifiers (e.g., Modifier 51, 59), and assistant surgeon billing.

• Follow up on outstanding insurance claims to ensure timely reimbursement • Manage denied and rejected claims and take appropriate corrective action • Prepare and submit claim appeals as needed • Investigate claim issues and identify root causes of payment delays or denials • Work and maintain 60, 90, and 120-day accounts receivable reports • Monitor and report on outstanding accounts receivable balances • Correct billing-related CPT and diagnosis code issues when necessary • Maintain accurate spreadsheets and AR tracking reports • Collaborate with the existing billing and account management team • Ensure HIPAA compliance and billing accuracy at all times

Role Description The Physician Coder codes and abstracts physician services performed in the hospital setting according to AHA, AMA guidelines and CMS directives. Must assure data quality through quarterly reviews. Performs data entry of physician services statistics into specialty-specific databases. Works with Medical Records, Finance, and Physician Billing to ensure appropriate flow of information. - Codes and abstracts professional fee hospital services performed by SLPG physicians from medical records according to ICD-9/ICD-10, CPT-4, HCPCS II, and CMS guidelines. - Utilizes 3M Encoder for validation of RVUs and CPT-4 procedure unbundling. - Maintains a 95% coding accuracy rate as measured through quality reviews. - Maintains daily productivity as outlined. - Responsible for maintaining up-to-date knowledge of coding guidelines as they relate to physician services for hospital inpatient, observation, consultant, surgical, critical care, and E & M services. - Performs data entry of abstracted physician information into specialty-specific databases. - Conducts educational sessions to the medical staff for coding and documentation compliance. Qualifications - RHIA, RHIT, CPC, OR CCS-P with working knowledge of ICD-9/ICD-10, CPT and HCPCS coding required. Requirements - Minimum 1-3 years experience in CPT/HCPCS physician procedural coding. - Previous experience with computerized patient record and coding system preferred. Physical and Sensory Requirements - Sitting for up to seven hours per day, three to four at a time. - Frequently uses fingers for typing, data entry, etc. - Frequent use of hands. - Use of upper extremities to rarely lift up to ten pounds. - Rarely stoops, bends, or reaches above shoulder level. - Hearing as it relates to normal conversation. - Seeing as it relates to general vision, near vision, peripheral vision and visual monotony. Application Instructions Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's! Company Description St. Luke's University Health Network is an Equal Opportunity Employer.