Verified Job
Work from home
Healthcare Practice Transformation Specialist
Work from home
#784162
Remote / WFH
PBACO Holding LLC
Job Description
Qualifications
The ideal candidate will be a Certified Professional Coder (CPC) with strong experience in Medicare, risk adjustment, and healthcare analytics
Certified Professional Coder (CPC) or equivalent certification
Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies
2+ years of medical coding, billing, or risk adjustment experience
Strong knowledge of ICD-10, CPT, and HCPCS coding and regulatory compliance
Excellent communication and training skills for working directly with providers and staff
This position requires 50-75% local travel and is eligible for standard IRS mileage reimbursement
Responsibilities
The Healthcare Practice Transformation Specialist will serve as a key liaison between physician practices and our organization
This role combines EHR training, clinical documentation review, risk adjustment coding, and billing support
Manage and support a physician network to ensure successful EHR integration and troubleshooting
Consult with medical practices to analyze workflows, configure EHR systems, and develop customized training plans
Train physicians and office staff on EHR best practices, regulatory compliance, and specialty-specific workflows
Review clinical documentation and medical records to ensure accurate ICD-10, CPT, and HCPCS coding for risk adjustment and quality gap closure
Conduct coding audits and provide education to providers on compliant documentation
Monitor payer guidelines and coding updates, especially for Medicare Advantage and accountable care organizations
Assist with billing, claims submission, payment posting, and collections as needed
Perform financial analysis and reporting using Microsoft Excel (pivot tables, trend analysis)
Analyze denial reports, identify trends, and recommend corrective actions
Support quality improvement initiatives by ensuring accurate coding for chronic conditions
Answer patient billing and claims questions in a professional and clear manner
Maintain compliance with HIPAA, coding regulations, and company policies
Participate in special projects, audits, and continuous process improvement initiatives
The ideal candidate will be a Certified Professional Coder (CPC) with strong experience in Medicare, risk adjustment, and healthcare analytics
Certified Professional Coder (CPC) or equivalent certification
Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies
2+ years of medical coding, billing, or risk adjustment experience
Strong knowledge of ICD-10, CPT, and HCPCS coding and regulatory compliance
Excellent communication and training skills for working directly with providers and staff
This position requires 50-75% local travel and is eligible for standard IRS mileage reimbursement
Responsibilities
The Healthcare Practice Transformation Specialist will serve as a key liaison between physician practices and our organization
This role combines EHR training, clinical documentation review, risk adjustment coding, and billing support
Manage and support a physician network to ensure successful EHR integration and troubleshooting
Consult with medical practices to analyze workflows, configure EHR systems, and develop customized training plans
Train physicians and office staff on EHR best practices, regulatory compliance, and specialty-specific workflows
Review clinical documentation and medical records to ensure accurate ICD-10, CPT, and HCPCS coding for risk adjustment and quality gap closure
Conduct coding audits and provide education to providers on compliant documentation
Monitor payer guidelines and coding updates, especially for Medicare Advantage and accountable care organizations
Assist with billing, claims submission, payment posting, and collections as needed
Perform financial analysis and reporting using Microsoft Excel (pivot tables, trend analysis)
Analyze denial reports, identify trends, and recommend corrective actions
Support quality improvement initiatives by ensuring accurate coding for chronic conditions
Answer patient billing and claims questions in a professional and clear manner
Maintain compliance with HIPAA, coding regulations, and company policies
Participate in special projects, audits, and continuous process improvement initiatives
