Role Description Properly codes and/or audits professional services for Inpatient and/or professional and hospital outpatient technical services for multiple specialty areas to ensure accuracy and optimal reimbursement from all third-party payers. - Reviews documentation in EPIC and/or on paper as provided to appropriately assign ICD-10-CM, PCS and CPT codes. - Communicates with and provides feedback to the education team and/or provider for query opportunities for documentation clarification or missing elements in the medical record. - Utilizes the encoder and/or Optum software to correctly assign all appropriate ICD-10-CM, ICD10-PCS and CPT codes for diagnosis and procedures. - Sequences diagnoses and procedures to generate clean claims in accordance with the Coding Guidelines based on the type of coding being reviewed. - Verifies all ADT information is correct on all charge sessions; date of service, billing provider, service provider, place of service, referral information and claim form if required. - Attends and participates in coding education sessions. - Obtains required CEU’s for certification and completes any required education. - Works coding related charge reviews/claim edits daily to ensure timely and accurate billing within filing deadlines. - The coder is responsible for productivity and quality standards to adhere with coding compliance and federal regulations. - Work all PB/HB claim edits and reject errors daily. - Hospital DNB’s will be worked as assigned per Specialty. - Work charge reconciliation to ensure all services provided are captured for coding in a timely manner. - Adheres to internal controls and reporting structure. Qualifications - Two years of medical billing or related experience, or related training from a non-accredited program or accredited agency. - Experience with Outpatient E/M level coding preferred. - Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology and medical abbreviations. Requirements - One of the following certifications is required: - CCA – Certified Coding Associate (AHIMA) - CCS – Certified Coding Specialist (AHIMA) - CCS-P – Certified Coding Specialist – Physician Based (AHIMA) - RHIA – Registered Health Information Administrator (AHIMA) - RHIT – Registered Health Information Technician (AHIMA) - CIC – Certified Inpatient Coder (AAPC) - COC – Certified Outpatient Coder (AAPC) - CPC – Certified Professional Coder (AAPC) - CPC-A – Certified Professional Coder – Apprentice (AAPC) - CRC – Certified Risk Adjustment Coder (AAPC) Working Environment/Equipment - Standard office environment at UTMB’s main campus or other location. - Occasional travel may be required. - Standard office equipment. Work Schedule - Remote Position, Monday through Friday, 8-hour shifts with availability between 6 AM - 6 PM. Equal Employment Opportunity UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Role Description We are seeking an exceptionally analytical, detail-oriented, and results-driven Virtual Medical Biller / Revenue Cycle Management (RCM) Specialist to manage the financial operations of our medical practice. Operating in a high-volume specialty environment, our brand represents financial integrity, meticulous compliance, and elite operational performance. This position is a dynamic, high-engagement financial operation designed to solve our clinic's most critical operational bottleneck: an accumulation of unresolved claims. We need a dedicated billing professional to systematically audit our history, resolve outstanding accounts receivable, and optimize the overall revenue cycle. You will serve as the primary engine driving our revenue recovery. Schedule & Daily Focus - Schedule: Full-Time, 40 hours per week | Monday – Thursday, 7:00 AM – 5:00 PM (US Timezone TBD) | Enjoy a 3-day weekend! - Immediate Priority: Backlog & Billing Cleanup (First few weeks) The primary challenge currently facing our clinic—and the driving force behind this hire—is a backlog of incorrect billing submissions and unbilled procedures. Your immediate focus during your first few weeks will be to: - Backtrack, audit, and correct historic billing filings that were submitted incorrectly. - Identify, compile, and bill outstanding, unbilled procedures. - Audit and capture neglected or unpaid patient/insurance payments to restore billing health. Standard Top 3 Daily Tasks (Post-Cleanup) - Accounts Receivable (A/R) Management: Reviewing aging reports, prioritizing outstanding balances, and actively pursuing aging claims. - Revenue Cycle Management & Claims: Overseeing the complete claim lifecycle from clean submission through final payment optimization. - Payer & Patient Phone Calls: Confidently handling inbound and outbound calls to resolve billing inquiries and negotiate with insurance adjusters. Core Responsibilities - End-to-End RCM Oversight: Manage the full medical billing lifecycle, ensuring clean claim submission, monitoring processing status, and securing timely reimbursements. - Aggressive A/R Reduction: Audit aging reports to identify, research, and systematically resolve unpaid, delayed, or underpaid claims with insurance carriers. - Denials & Appeals Navigation: Deeply investigate denied or rejected claims to pinpoint root causes, correct billing or modifier errors, and submit robust appeals to recover revenue. Insurance Verification & Phone Operations - Insurance Benefit Navigation: Execute comprehensive insurance eligibility and benefit verifications, ensuring active coverage is accurately documented. - Elite Phone Management: Command inbound and outbound lines with a highly articulate, professional, and confident presence when communicating with insurance companies and handling patient billing inquiries. - EHR Documentation Excellence: Maintain meticulous documentation of all collection efforts, backlog auditing, and financial adjustments within the ModMed (EMA) ecosystem. Qualifications - Proven experience in U.S. medical billing, accounts receivable, and collections. - Prior experience in Ophthalmology or Retina billing is highly preferred. - Proven track record of auditing historical billing records, identifying missing/unbilled procedures, and successfully reconciling aged accounts. - Direct hands-on experience navigating ModMed (EMA) EHR is a strong plus. - Technical proficiency with medical clearinghouses and digital billing workflows is required. - Flawless verbal and written English communication skills. - Solid, practical understanding of commercial insurance structures, claims tracking, CPT/ICD-10 coding guidelines, and modifier usage. - Ability to work independently from a completely silent, distraction-free virtual home office equipped with high-speed internet and a professional headset. Ideal Candidate Profile The ideal candidate thrives on "clean-up" projects and takes complete ownership of revenue recovery. You are a billing detective who enjoys looking at historic ledgers, identifying where filings went wrong, and capturing money left on the table. You are proactive, highly analytical, and ready to make an immediate financial impact.

• Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations. • Serves as part of a team of coding denials resolution specialists responsible for identifying and determining root causes of denials. • Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers. • Promotes departmental awareness of coding best practices.

Role Description Abstract pertinent clinical information from patient records and translate complex healthcare services into the appropriate financial language by assigning the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) codes. This includes performing complex coding and determining accurate Ambulatory Patient Classification (APC) or Diagnosis-Related Group (DRG) assignments. - Maintain consistently high productivity and quality rates defined by our coding policy, delivering work with a high degree of precision and attention to detail. - Act as a critical resource by proactively querying physicians when documentation is ambiguous, inadequate, or unclear, ensuring complete and accurate code assignment. - Uphold the highest ethical standards as set forth by the American Health Information Management Association (AHIMA), maintaining deep knowledge of and strict adherence to official coding guidelines and reimbursement reporting requirements. Qualifications - One or more of the following required: - Certified Coding Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or job transfer date. - Certified Professional Coder (CPC) credentialed from the American Academy of Professional Coders (AAPC) obtained prior to hire date or job transfer date. - Coder obtained prior to hire date or job transfer date. - Reg Health Info Admnstr credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or job transfer date. - Reg Health Info Tech credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or job transfer date. - High School diploma equivalency OR 1 year of applicable cumulative job specific experience required. - Note: Required professional licensure/certification can be used in lieu of education or experience, if applicable. Benefits - Paid time off (PTO) - Various health insurance options & wellness plans - Retirement benefits including employer match plans - Long-term & short-term disability - Employee assistance programs (EAP) - Parental leave & adoption assistance - Tuition reimbursement - Ways to give back to your community