• Credentialing individual providers and group with payors
• Reviewing medical records for provider documentation standards
• Reviewing medical records for additional revenue opportunities
• Reviewing table builds in Athena to ensure clean claim submission
• Submitting claims
• Assessing payor rejections and denials for provider credentialing issues
• Working claims escalated by the billing partner to ensure corrected claims are filed within payor timely filing deadlines
• Ensuring compliance with NCCI (National Correct Coding Initiative)
• Using CPC knowledge to code and submit claims for MD Ally patient encounters
• Provide recommendations on coding strategy
• Recommend opportunities to increase revenue
• Other RCM, payor contracting & enrollment, and related tasks, as requested

CPC License Required

JOB CODE: 1000040