Role Description We are seeking a detail-oriented and motivated Medical Billing Manager to join our growing healthcare team. This role is responsible for reviewing, researching, and resolving unpaid or denied insurance claims while ensuring accurate and timely reimbursement for medical services rendered. The ideal candidate is highly organized, an effective communicator, and comfortable working independently in a remote yet collaborative environment. - Review and follow up on outstanding medical insurance claims and unpaid balances - Investigate denied or underpaid claims and take corrective action as needed - Communicate with insurance carriers regarding claim status, appeals, eligibility, and payment discrepancies - Submit corrected claims and appeals in a timely manner - Maintain accurate documentation of account activity and follow-up efforts - Work collaboratively with billing, coding, and administrative teams to resolve claim issues - Identify trends in denials and recommend process improvements - Ensure compliance with HIPAA and all applicable healthcare billing regulations - Meet productivity and quality standards while managing multiple accounts and deadlines Qualifications - Certified Professional Coder (CPC) required - Previous experience in medical billing, insurance follow-up, or revenue cycle management preferred - Familiarity with EMR/EHR systems and medical billing software - Knowledge of insurance guidelines, CPT/ICD-10 coding, and payer requirements - Experience handling appeals and claim denials - Current Employees: must have been employed by ResPro for 6 months Preferred Qualifications - Proficient knowledge, skill, and interest in basic computer skills - Strong problem-solving skills with the ability to multi-task effectively - Excellent verbal and written communication skills - Excellent teamwork and collaboration skills - Comfortable working remotely while maintaining strong communication with team members - Strong attention to detail and organizational skills - Ability to work independently and manage priorities efficiently - Clean background check required Benefits - Comprehensive Health Care Plan (Medical, Dental, Vision) - Flexible Paid Time Off - Full Time position with a salary range of $60,000 - $65,000

• Review and accurately code medical records and encounters for diagnoses and procedures related to Risk Adjustment and HCC coding guidelines. • Ensure coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines. • Validate and ensure the completeness, accuracy, and integrity of coded data. • Identify and resolve coding discrepancies or discrepancies between clinical documentation and diagnosis coding. • Stay up-to-date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding. • Adhere to all compliance and HIPAA regulations to maintain data security and patient confidentiality. • Collaborate with healthcare providers, physicians, and other team members to clarify documentation and resolve coding queries. • Participate in coding education and training programs to enhance coding skills and knowledge. • Prepare and submit reports related to coding activities, coding accuracy, and any coding-related issues or trends. • Assist in internal and external coding audits to ensure the quality and compliance of coding practices. • Identify opportunities for process improvement and efficiency in the coding process. • Offer suggestions to enhance coding documentation and accuracy.

• Accountable for conversion of outpatient diagnoses and treatment procedures into codes using an international classification of diseases, and HCPCS codes based on documentation in the patient’s record, are coded accurately and in a timely manner. • Reviews and validates all diagnoses/procedures stated by physician and other healthcare providers. • Ensures that records are coded within 48 business hours of discharge. • Notifies director whenever work is more than 48 hours behind work deadline. • Meets productivity standard of assigning codes to a minimum of 25 charts per hour. • Partners with charting physician if diagnosis is not transcribed to assure all required documentation is presented to meet compliance accuracy in coding and severity of illness is charted and coded. • Codes diagnoses and procedures on based on documented information in the patient’s record that agree with physician’s preference 90% of the time. • Utilizes computerized coding/abstracting equipment. • Codes outpatient for diagnoses/procedures in accordance with international classification of diseases and HCPCS coding principles and the Coding Manual. • Meets quality standards of having 95% of diagnoses and procedures appropriately and/or correctly coded. • Maintains 99% rate of information correctly abstracted. • Reviews coding periodicals within 7 days of receipt. • Maintains credential continuing education as per credential held.

Role Description We are seeking experienced Medical Coders with a strong background in Risk Adjustment and Hierarchical Condition Category (HCC) coding. The ideal candidate will hold at least a CPC or CCS certification from AHIMA or AAPC, and higher-level certifications are highly desirable. As a Medical Coder specializing in Risk Adjustment/HCC, you will play a crucial role in ensuring accurate and compliant coding for our healthcare organization. - Review and accurately code medical records and encounters for diagnoses and procedures related to Risk Adjustment and HCC coding guidelines. - Ensure coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines. - Validate and ensure the completeness, accuracy, and integrity of coded data. - Identify and resolve coding discrepancies or discrepancies between clinical documentation and diagnosis coding. - Stay up-to-date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding. - Adhere to all compliance and HIPAA regulations to maintain data security and patient confidentiality. - Collaborate with healthcare providers, physicians, and other team members to clarify documentation and resolve coding queries. - Participate in coding education and training programs to enhance coding skills and knowledge. - Prepare and submit reports related to coding activities, coding accuracy, and any coding-related issues or trends. - Assist in internal and external coding audits to ensure the quality and compliance of coding practices. - Identify opportunities for process improvement and efficiency in the coding process. - Offer suggestions to enhance coding documentation and accuracy. Qualifications - Minimum CPC or CCS certification from AHIMA or AAPC is required. Higher-level certifications such as CRC (Certified Risk Adjustment Coder) is a significant advantage. CPC-A (Apprentice) certification will not be considered for this position. - Minimum one to two years of experience in Risk Adjustment and HCC coding in a healthcare setting. - Strong knowledge of ICD-10-CM coding guidelines and CMS-HCC risk adjustment methodology. - Familiarity with electronic health record (EHR) systems and coding software. - Excellent attention to detail, analytical skills, and ability to work independently. - Strong communication and interpersonal skills for collaboration with medical professionals and team members. - Understanding of compliance and confidentiality regulations, including HIPAA. Requirements - Applicant should be available to work from 6 AM to 6 PM EST. - Must commit to a minimum of 20 hours per week, Monday through Friday. - Preference for candidates who can commit to a full-time schedule of 40 hours per week. - This position follows a Bring Your Own Device (BYOD) policy. - Candidates must have a Windows-based laptop/desktop with Windows Professional Edition (Windows Pro) and a reliable high-speed internet connection. - Systems running Windows Home Edition are not compatible with the security requirements for this role. Benefits - Pay Rate: $22/hr.