5 jobs found

About the Role  We are seeking a medical billing and coding expert to support clients and internal  go-to-market teams by evaluating the reimbursement readiness of novel care delivery  models. This is not a production coding or revenue cycle role. It is a strategic advisory  position designed for experienced coding professionals who want to influence product  design, commercialization strategy, and payer alignment, not just apply existing rules. You will help answer questions such as:  • Can this service plausibly be billed today, and if so, how?  • What precedent exists, even if indirect?  • Where do coding constraints meaningfully limit scale or revenue?  • What changes to workflow, documentation, or product design improve feasibility?  Engagement Model  This is a project-based, independent contractor role, not a traditional full-time position.  Engagements are scoped and staffed on a per-project basis, typically starting with one or  two defined projects to assess...

A Certified Physician Practice Manager oversees the daily operations, business performance, and staff of a medical practice to ensure high‑quality, efficient, and financially sound patient care. Primary Responsibilities Oversee day‑to‑day clinic operations (scheduling, front desk, billing, medical records, patient flow) Manage and develop staff (hiring, training, performance reviews, staffing schedules) Monitor financial performance (budgeting, revenue cycle, A/R, coding and billing accuracy, cost control) Ensure compliance with laws, accreditation standards, payer requirements, and practice policies Optimize patient experience (access, wait times, communication, service recovery) Implement and improve practice workflows, policies, and quality initiatives Oversee EHR/practice management systems and coordinate with IT/vendors Partner with physicians on strategic planning, service line growth, and marketing/outreach...

A Certified Inpatient and Outpatient Professional Documentation Expert is responsible for ensuring the accuracy, completeness, and compliance of clinical documentation across both inpatient and outpatient settings. They collaborate with physicians, nurses, and other providers to clarify diagnoses, procedures, and treatment plans so that the medical record supports the patient’s severity of illness, risk of mortality, medical necessity, and appropriate reimbursement. Key duties include concurrent and retrospective chart review, generating and tracking provider queries, applying official coding and documentation guidelines, educating clinical staff on best practices, and monitoring documentation quality metrics to support regulatory, audit, and revenue cycle integrity.

The Certified Professional Medical Auditor is responsible for performing comprehensive audits of medical records, coding, and billing to ensure accuracy, compliance with federal and state regulations, and alignment with payer policies. This role helps protect the organization from financial risk, supports accurate reimbursement, and promotes high standards of documentation and clinical integrity. Key Responsibilities Perform prospective and retrospective audits of medical records, coding, and billing across assigned service lines (e.g., outpatient, inpatient, behavioral health, SUD/MH, lab). Verify that documentation supports ICD‑10‑CM, CPT, and HCPCS coding; identify under‑coding, over‑coding, unbundling, and other compliance risks. Review claims for adherence to Medicare/Medicaid, commercial payer, and regulatory guidelines; ensure compliance with NCCI edits and payer‑specific policies. Prepare clear, detailed audit reports summarizing findings,...

📍 Wilmington, DE  🕓   Full-Time on-site | Healthcare Administration | Revenue Cycle Management About D’Souza & Associates For over 35 years,   D’Souza & Associates   has helped physicians and healthcare practices across the U.S. get paid accurately and on time. We’re a technology-driven medical billing and revenue cycle management firm that believes in precision, accountability, and continuous improvement. We combine human expertise with smart automation to simplify healthcare operations — and we’re looking for detail-oriented, motivated professionals to grow with us. What You’ll Do Enter and review patient, insurance, and billing data for accuracy Research and resolve claim issues and denials through payer communication and analysis Track claims and payments to ensure timely reimbursement Collaborate with internal teams and physician offices to clarify billing details Prepare and summarize reports on claim and payment activity Handle...