Role Description - Ensure the preparation of accurate and compliant medical insurance claims for timely submission. - Oversee the submission of claims to insurance companies, ensuring adherence to deadlines to avoid delays in payments. - Address claim denials by coordinating resubmissions, crafting detailed appeal letters, and working toward resolutions. - Develop and implement proactive strategies to minimize claim denials, ensuring continuous improvement in billing processes. - Continuously stay updated on the latest billing requirements, guidelines, and regulations specific to various medical specialties, states, and insurance carriers. - Adapt billing practices to ensure compliance with industry standards and streamline claim submission processes. - Follow all client and team policies, procedures, and guidelines to maintain consistency, compliance, and accuracy. Qualifications - Open to candidates with or without experience, though individuals with 1-6 years of medical billing experience will be given priority consideration. - Consultancy basis minimum of 6 months consultancy contract (subject for renewal). - Familiarity with various insurance policy types, including PPO, HMO, and MediCal, is preferred but not required. - Ability to navigate Healthcare Practice Management systems is a plus, though not mandatory. - Strong attention to detail, accuracy, and excellent time management skills are essential. - Must possess excellent communication skills in English, both written and verbal. - Proficient data entry skills, with a typing speed of 40 WPM or faster, are required. - Must demonstrate the ability to work with and protect confidential information. - Able to work from home with reliable internet and a backup connection. Benefits - Work from Home. - Equipment/company computer is provided. Company Description

• Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify accuracy, completeness, specificity, and appropriateness of diagnosis codes • Assist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement • Interpret medical documentation to ensure all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives is captured • Develop tools and metrics to improve accuracy and completeness of coding and documentation • Provide a high level of customer service to internal and external clients by meeting and/or exceeding expectations including quality and productivity standards • Escalate appropriate coding audit issues to management as required • Participate in and support ad-hoc coding audits as needed • Support ongoing programs which minimize organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit • Work assigned coding projects to completion • Other duties as assigned

• Responsible for accurate and timely coding of hospital inpatient, outpatient and/or professional fee encounters using ICD10/ICDPCS, CPT, or HCPCs codes • Responsible for understanding and applying all regulatory coding guidelines • Develops methodology for a coding process compliant with regulatory agencies • Facilitates optimization of revenue while maintaining compliance standards • Serves as an expert resource regarding various coding systems and regulatory guidelines • Reports documentation and coding improvement needs based on review findings • Performs provider and peer coding audits as requested • Monitors internal controls for coding and billing

• Code medical records to validate ICD-10-CM codes for PACE Risk Adjustment • Meet department production and quality standards • Research regulatory guidelines for supporting documentation • Prepare coding reports using excel • Prepare oral and/or written reports of work activity to Supervisor • Be responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information. • Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach • Other duties as assigned