Role Description - Oversee end-to-end medical billing and claims submission operations across professional fee and/or facility billing environments. - Evaluate AI-generated billing outputs, claim edits, and coding validations for accuracy and payer compliance. - Manage claims submission workflows including electronic claim generation, clearinghouse edits, and payer-specific billing requirements. - Monitor clean claim rates, rejection rates, and first-pass acceptance rates. Develop improvement strategies. - Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections. - Ensure compliance with CMS billing guidelines, HIPAA 837 transaction standards, and payer-specific billing rules. - Annotate AI outputs and provide structured feedback to support AI training datasets. Qualifications - Must-Have: - 5+ years of experience in medical billing and claims management, with at least 2 years in a management role. - Deep knowledge of professional fee (CMS-1500/837P) and/or facility (UB-04/837I) billing requirements. - Expertise in HIPAA 837 transaction standards, clearinghouse operations, and payer-specific billing rules. - Strong understanding of Medicare, Medicaid, and commercial payer billing requirements. - Proficiency with billing platforms (Epic, Athenahealth, AdvancedMD, or equivalent) and clearinghouse tools. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify billing errors and compliance issues in AI-generated outputs. - Preferred: - CPC, CCS, CHFP, or CRCR certification. - Experience with automated billing platforms and RCM technology implementations. - Background in multi-specialty physician group, hospital, or health system billing operations. - Familiarity with AI tools and comfort evaluating AI-generated billing content. - Experience with payer contract interpretation and billing compliance program management. Application Process - Upload resume - AI interview based on your resume - Submit form Resources & Support - For details about the interview process and platform information, please check: Interview Process - For any help or support, reach out to: support@mercor.com - Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.

Role Description - Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA risk adjustment programs. - Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy and regulatory compliance. - Review medical records to ensure complete and accurate capture of HCC-eligible conditions supported by clinical documentation. - Conduct and oversee retrospective and prospective chart reviews for risk score optimization. - Manage RADV audit preparation and response processes. - Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes. Qualifications - Must-Have: 5+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, with at least 2 years in a leadership role. - Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies. - Strong knowledge of ICD-10-CM coding guidelines as applied to HCC risk adjustment. - Experience with RADV audit preparation and CMS compliance requirements. - Familiarity with RAPS and EDGE submission processes. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify coding inaccuracies and documentation gaps in AI-generated outputs. - Preferred: CRC (Certified Risk Coder), CCS, CPC, or RHIA credential. - Experience with risk adjustment analytics platforms and chart retrieval systems. - Background in health plan, Medicare Advantage organization, or value-based care setting. - Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content. - Experience presenting risk adjustment performance to actuarial or executive teams. Application Process - Upload resume - AI interview based on your resume - Submit form Resources & Support - For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome - For any help or support, reach out to: support@mercor.com - PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.

Role Description Supervises the coding function and corresponding staff. Oversees reimbursement process. Manages auditing and quality control and improvement initiatives. Ensures compliance with internal policies and procedures and governing agencies. Works with managers to assist with departmental needs and planning, including developing policies and procedures to facilitate timely and accurate reimbursement. Qualifications - H.S. Diploma or General Education Degree (GED) Required - 3 years of Physician Coding/HIM experience Required - Specialty Coding experience Preferred - Experience in coding across multiple practices and remote coding experience Preferred - RHIA - Registered Health Information Administrator or - RHIT - Registered Health Information Technician or - CCA - Certified Coding Associate or - CPC or CPC-H or - CCS or CCS-P Company Description At Piedmont Healthcare, you’ll love a shared purpose, be motivated to be your best, and be recognized for your contributions. Piedmont Healthcare leaders are in your corner and invested in your success. Our wellness programs and comprehensive total benefits and rewards will meet your needs for today and help you plan for the future.

Role Description At Piedmont Healthcare, you’ll love a shared purpose, be motivated to be your best, and be recognized for your contributions. Piedmont Healthcare leaders are in your corner and invested in your success. Our wellness programs and comprehensive total benefits and rewards will meet your needs for today and help you plan for the future. - Reviews, analyzes, and codes medical record documentation to include, but not limited to, medical, diagnostic, and procedural information for the correct ICD-10, CPT and/or HCPCS codes to the greatest specificity. - Abstracts demographic and coding information into the information system accurately and completely. - Reviews documentation for medical necessity. - Audits orders and claims before submission for accuracy and to minimize claim denials. - Assesses records and prepares reports. - Provides technical guidance to physicians and other departmental staff in identifying and resolving issues or errors. - Develops effective working relationships with physicians and other stakeholders. - Primary coding responsibility is all Evaluation and Management (E/M) leveling along with additional ancillary services done in an office setting. Qualifications - H.S. Diploma or General Education Degree (GED) Required - Coding Certificate program (AAPC accredited) is Preferred - No experience required Required - Coding experience Preferred - Remote coding experience is Preferred - One or more of the following certifications: Required - RHIA - Registered Health Information Administrator or - RHIT - Registered Health Information Technician or - CCA - Certified Coding Associate or - CPC or - CPC-A or - CPC-H or - CCS or - CCS-P Company Description Piedmont Healthcare Corporate