Role Description Provides support to coders and is required to possess in-depth knowledge of billing and coding guidelines. Responsible for onboarding all new coders, as well as providing support and training to existing coders when indicated. This role provides daily administrative support, including: - Productivity monitoring - Quality assurance reviews - Timekeeping - Workflow management Strong interpersonal and communication skills are required to help maintain team cohesiveness and lead effective change. Eligible remote states include NC, FL, GA, SC, SD, TN, TX and VA. Qualifications - Certified Professional Coder - Registered Health Information Administrator - Registered Health Information Technician - Certified Documentation Improvement Practitioner - Certified Coding Specialist Requirements - High School Diploma or Equivalent Required - Associate's Degree in Health Information Management Preferred - 4 Years Coding - Physician Required - 8 Years Coding - Physician Preferred Company Description Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit www.wakemed.org .

Role Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our physician practices remotely! In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. What You'll Do - Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company. - Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC). - Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines. - Interact with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. - Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing. - Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes. Stay informed about changes in Medicare, Medicaid, and private payer requirements. - Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. - Train, mentor and support new employees during the orientation process. Function as a resource to existing staff for projects and daily work. - Provide peer to peer guidance through informal discussion and overread assignments. Support coder training and orientation as requested by manager. - May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I. - Other duties as assigned. Qualifications - Certified Professional Coder (CPC) or CRC from AAPC. - Certified Risk Adjustment Coder (CRC) certifications from AAPC. - At least 3 years of experience in risk adjustment experience. - At least 1 year experience with provider education. - PC skills and experience using Microsoft applications such as Word, Excel, and Outlook. - Excellent presentation, verbal and written communication skills, and ability to collaborate. - Must possess the ability to educate and train provider office staff members. - Proficiency with healthcare coding software and Electronic Health Records (EHR) systems. - Strong knowledge with PowerPoint, preparing presentations, and public speaking. - Strong experience with Excel - reports, pivot tables, VLOOKUP, etc. Requirements - Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC highly preferred. - Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage. - Experience with multiple EMR/EHR systems. - Experience with Monday.com and PowerBI. - Ability to work independently and collaborate in a team setting. - Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting. Environmental Job Requirements and Working Conditions - This is a full-time position, operating M-F 830 AM - 5 PM EST. - This is a remote position. The home office is aligned at 1600 Corporate Center Drive, Monterey Park, CA. - We are seeking candidates who reside in CST or EST time zones. - The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

• Prepare, review, and submit accurate medical claims to insurance providers and government healthcare programmes. • Monitor submitted claims and track their progress through to payment. • Investigate and resolve rejected, denied, or unpaid claims. • Perform accounts receivable (A/R) follow-up to ensure timely reimbursement. • Submit corrected claims and appeals where necessary. • Ensure all claims are submitted within payer filing deadlines. • Maintain accurate provider, patient, and billing records. • Review billing documentation for completeness and accuracy before claim submission. • Verify billing information and resolve discrepancies. • Maintain organised billing files and supporting documentation. • Liaise with insurance companies, governing agencies, and healthcare providers regarding billing enquiries and claim status. • Build and maintain effective working relationships with providers, management, and external stakeholders. • Provide updates on outstanding claims and reimbursement issues. • Ensure billing activities comply with healthcare regulations, payer requirements, and company policies. • Maintain confidentiality of patient and provider information. • Support internal audits and quality assurance processes.

Role Description We are looking for a detail-oriented Medical Billing Administrator to join our healthcare team. In this role, you will be responsible for the end-to-end medical billing process, ensuring healthcare providers receive accurate and timely reimbursement for services rendered. You will prepare, review, submit, and follow up on medical claims while working closely with insurance providers, governing agencies, and internal teams to resolve billing issues and minimise claim denials. This role requires excellent attention to detail, strong organisational skills, and a commitment to accuracy, compliance, and delivering exceptional support to both providers and patients. Experience in Speech Therapy or ABA (Applied Behavior Analysis) billing is highly advantageous. - Prepare, review, and submit accurate medical claims to insurance providers and government healthcare programmes. - Monitor submitted claims and track their progress through to payment. - Investigate and resolve rejected, denied, or unpaid claims. - Perform accounts receivable (A/R) follow-up to ensure timely reimbursement. - Submit corrected claims and appeals where necessary. - Ensure all claims are submitted within payer filing deadlines. - Maintain accurate provider, patient, and billing records. - Review billing documentation for completeness and accuracy before claim submission. - Verify billing information and resolve discrepancies. - Maintain organised billing files and supporting documentation. - Liaise with insurance companies, governing agencies, and healthcare providers regarding billing enquiries and claim status. - Build and maintain effective working relationships with providers, management, and external stakeholders. - Provide updates on outstanding claims and reimbursement issues. - Ensure billing activities comply with healthcare regulations, payer requirements, and company policies. - Maintain confidentiality of patient and provider information. - Support internal audits and quality assurance processes. Qualifications - Minimum 1 year of medical billing experience. - Previous experience working within the healthcare industry. - Understanding of medical billing processes and the revenue cycle. - Knowledge of the credentialing process is advantageous. - Excellent attention to detail and organisational skills. - Ability to manage multiple priorities and meet deadlines. - Strong communication and problem-solving skills. - Ability to work independently and as part of a team. - Comfortable working in a fast-paced, growing environment. - Comfortable working U.S. hours. Benefits - Remote work from home. Fraud Disclaimer ReWorks Solutions will never request payment during recruitment or require in-person office visits. All official communication will come from a ReWorks Solutions email address. Please verify any suspicious messages with our team directly.