6 jobs found in Remote

For over 30 years, Welter Healthcare Partners has collaborated with healthcare organizations across the US on the business of healthcare. Healthcare is complicated and ever-changing, and our services, solutions, highly specialized and collaborative teams are focused on helping drive results for the long-term success of our clients! We are looking for new team members that share the same passion for success!   We are looking for a 1099 Surgical Coding Expert, primarily Orthopedics, who seeks ownership of their craft, asserts their interpretation of guidelines and rules and who is extremely particular about the highest level of quality of their coding work! Skilled auditor preferred; however, a skilled and detail-oriented coder with the desire to transition to auditing will be highly considered.   We offer up to $4,000 flat fee per month and are flexible for more depending on the ability to organize and facilitate volume, but quality over quantity. Opportunity...

Essential Functions: Coordinates with Compliance Audit Manager and Sr. Audit Director on any billing compliance investigations. Reviews and audits documentation in the medical records and charges submitted including CPT and ICD-10information to ensure compliance. Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing are being performed in an accurate and timely manner and is supported by documentation. Analyzes billing trends to identify areas of non-compliance and prepares regular reports on audit findings to Compliance Manager. Collaborates with the Compliance Team to develop annual audit work plans. Educates providers when deficiencies in documentation and code selection are identified. Develops corrective action plans and participates in compliance investigations as needed. Performs other duties as...

The Medical Policy Manager is responsible for overseeing all cap thresholds and medical review triggers, ensuring they are routed either for administrative evaluation by the vendor or referred to the state’s Utilization Management (UM) vendors for clinical review. Qualifications Certified Coding Specialist credential issued by the American Health Information Management Association (AHIMA) Minimum of five years’ experience creating and administering medical and/or Utilization Management (UM) policies for state Medicaid programs or Medicare Strong working knowledge of Centers for Medicare & Medicaid Services (CMS) procedure and diagnosis coding, including dental and Current Dental Terminology (CDT) codes Bachelor’s degree in a related discipline

About the role We run a fast-growing care management program billed under partner clinic TINs across a mixed payer population. We need an expert to tighten CoCM billing yield while keeping documentation audit-proof as we scale from ~24 clinics to 100+. The right candidate will be able to convert this into a full-time role with equity, and grow with the company. Looking to hire ASAP. What you’ll own Design and audit CoCM and CCM billing workflows , including appropriate patient stratification between programs. Define clear, defensible criteria for assigning patients to CoCM vs CCM (and transitions over time). Build “gold standard” documentation templates and checklists for 99492/99493/99494, 99490, 99439 , and related codes as applicable. Design simple, audit-proof time capture and attribution workflows across care team members. Create and run a QA sampling plan with feedback loops for care teams and clinic billers. Partner with...