Title: Ambulatory OBGYN Nurse BWH Location: Boston-MA United States Work Type: Onsite, Part Time Job ID: RQ4067242 Job Description: Site: The Brigham and Women's Hospital, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. The Registered Nurse is a professional nurse registered in Massachusetts who is responsible and accountable for planning and providing patient care for assigned patients in accordance with Nursing Standards of Care as set forth in the Nursing Department's Clinical Practice Manual. The Registered Nurse demonstrates initiative, knowledge, and clinical skills in caring for the patient with complex needs. The Registered Nurse demonstrates the ability to effectively manage patients by assuming full responsibility for the assessment, plan, implementation, and evaluation of patient care and is directly responsible to a designated nurse manager or supervisor. For newly licensed nurses, a Bachelor of Science Degree in Nursing is required. Nursing at Brigham and Women's Hospital is known for their excellent clinical practice and for keeping patients and their families at the center of all they do. We understand that great care is shaped by relationships with patients and their families. That's why we're committed to knowing our patients on a deeper level - not just as patients, but as individuals - to ensure that they, and their families, feel known and cared for. At BWH, we proudly work together with a spirit of inquiry and a deep commitment to providing the highest quality, evidence-informed and theory-guided care. We work each day to achieve our vision - to provide excellent care to patients and families, with the best staff, in the safest environment. Just as we have been able to reinvent health care, we have also transformed health care careers. Whether measured in terms of lives saved, awards earned, or the personal satisfaction of stretching your talents - a career with BWH is unlike any other in the health care field. Here you'll find a workplace where collaboration and teamwork are the norm, not the exception - physicians, nurses, technicians, staff and management form a close-knit bond, based on mutual respect and devotion to our patients. If you want an enormously fulfilling career, there's no better place to be. The Staff Nurse will be responsible for: - Providing care for patients at the BWH main campus in the General/Resident OB clinic supporting both resident and midwife patients - Telephone Triage of OB Patients - Communicating with and providing nursing care to OB Patients via Patient Gateway - Working collaboratively to provide excellent care to patients and families in the safest environment - Working collaboratively with attending physicians, midwives, residents, fellows, physician assistants, social workers, and medical and practice assistants to meet the needs of our obstetric patients. - Administration of IM, SC, and PO medications as ordered and per protocol. - Interpretation and follow-up routine prenatal labs and genetic testing per protocol. - Patient education on obstetrical topics, including birth control counseling - Maintaining flexibility in meeting the changing needs of clinic assignments and workflows. - Must be a team player, multi-tasker, hardworking, reliable, trustworthy, and empathetic. - Working collaboratively to provide excellent care to patients and families in the safest environment. Qualifications Education: - Graduate of an approved school of nursing with current registration in Massachusetts. A Bachelor of Science Degree in Nursing is required for newly licensed nurses. Experience: - A minimum of 3 years of clinical nursing experience is required. - Nursing experience in an ambulatory OB clinic/practice setting is required. - L&D nursing experience preferred. - Postpartum nursing experience is preferred. - Bilingual is preferred. Other: - Membership in professional organizations is recommended and certification in a specialty area is preferred. - Able to work weekend rotation per the MNA contract. Additional Job Details (if applicable) Remote Type Onsite Work Location 45 Francis Street Scheduled Weekly Hours 24 Employee Type Regular Work Shift Day (United States of America) Pay Range $41.71 - $105.65/Hourly Grade MNA333

Title: Senior Medical Billing and Coding Coordinator (US Remote) Location: United States Job Description: Description & Requirements Maximus is seeking a Senior Medical Billing and Coding Coordinator to support our California Independent Medical Review (IMR) project-all from the comfort of your home. This fully remote position offers flexibility while enabling you to take ownership of complex case reviews and contribute to healthcare integrity. This is a full-time, fully remote position within the United States. This position is ideal for professionals who thrive in remote settings, value autonomy, and bring sharp analytical skills to regulatory decision-making. Why Maximus? Work/Life Balance Support - Flexibility tailored to your needs! ️ Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short- and Long-Term Disability coverage. Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). Recognition Platform - Acknowledge and appreciate outstanding employee contributions. Tuition Reimbursement - Invest in your ongoing education and development. Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs. Professional Development Opportunities-Participate in training programs, workshops, and conferences. Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees Essential Duties and Responsibilities: - Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data. - Enter coded data into a system accurately and validate date entered. - Research correct coding practices, clearly document and share findings with others. - Write clear and concise rationales that provide defensible support of decisions. - Train staff members on the coding processes (both project specific and general coding). - Perform QA audits on coding process. - Recommend and suggest improvements to assigned projects. - Perform other duties as assigned by management. - Apply California Workers' Compensation regulations and calculate fee schedule allowances. - Evaluate the accuracy and appropriateness of coded and billed medical information - Develop final determination letters based on regulatory and clinical standards - Abstract key data from complex case files and medical records - Assign and verify CPT, HCPCS, and ICD-10-CM codes using industry-standard billing guidelines - Apply specialized regulations including California Workers' Compensation, CMS policies, AMA CPT coding guidelines, and CA fee schedules - Collaborate virtually with cross-functional teams to drive quality and compliance Minimum Requirements - High school diploma or equivalent with 4+ years of experience, or AA with 2+ years of experience. - Preferred risk adjustment auditing experience of coding inpatient and outpatient medical records. - CPC, CCS, or RHIT Certification required. - Ability to use critical thinking skills. - Must have excellent writing skills. - Experience coding physician, inpatient and/or outpatient medical records required. - Strong computer skills, including Word, Excel, and Outlook. - Mathematical skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. - Active CPC, CCS, CIC, COC, CCS or RHIT certification required (AAPC or AHIMA accredited) Preferred Requirements - Bachelor's degree from an accredited institution - Experience as a medical claim examiner, reviewing physician and hospital PPO contracts - Experience with California Workers' Compensation Official Medical Fee Schedule - Experience with CMS payment methodologies: IPPS, OPPS, DMEPOS and Physician Fee Schedule Home Office Requirements - Maximus provides company-issued computer equipment - Private and secure workspace - Reliable high-speed internet service - Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity - Minimum 5 Mpbs upload speeds #ClinicalServices #LI-Remote EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.

• 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.