All Care To You

Data Engineer

• Design, develop, and maintain high-quality real-time data marts
• Collaborate with cross-functional teams to define, design, and build new data marts
• Write clean, scalable, and efficient code
• Conduct code reviews and provide constructive feedback to peers
• Create and maintain technical documentation, policies, data models and ETL processes in ACTY WIKI.
• Participate in software testing and upgrades
• Ensure the performance, quality, and responsiveness of the data for applications
• Tune SQL queries, stored procedures, indexes, and views to support high-throughput analytics
• Monitor data performance and indexing.
• Data business rule enforcement to alert users of duplicate reduce manual intervention.
• Automate recurring data tasks, and data quality checks using scripting and scheduling tools
• Implement safeguards and automated checks to minimize the impact of user-driven data mart integrity issues.
• Participate in architecture and design discussions to drive technical excellence
• Mentor junior developers and share best practices

Senior Data Engineer

Administrative Assistant

• Assist with scheduling and coordinating internal and external meetings.
• Prepare agendas, minutes, and meeting materials.
• Coordinate with providers on agenda updates and additional items.
• Maintain department policies, procedures, and SOPs.
• Maintain provider training resources.
• Maintain department WIKI pages in Confluence.
• Manage special projects using Atlassian, Confluence, and Azure.
• Be an internal and external facilitator between ACTY and clients to maintain and ensure customer happiness.
• Support the implementation of new processes, tools, or systems utilized to support billing services.
• Utilize strong problem-solving skills to address challenges and find efficient solutions.
• Maintain confidentiality and adhering to the highest ethical standards in our extremely sensitive and private environment.
• Demonstrate excellent written and verbal communication skills in all interactions with internal and external stakeholders.
• Provide support to Billing & Provider & Member Engagement departments as needed.
• Other duties and projects as needed.

Provider & Billing Services Administrative Coordinator

Billing Specialist

• Ensures timely and accurate reimbursement by managing outstanding claims and collaborating with insurance carriers, providers, and billing teams
• Requires strong problem-solving skills to resolve complex billing issues and maintain compliance with industry standards
• Key role in early detection of problems ensuring claims are processed accurately and promptly
• Maintain client satisfaction, providing critical support to ensure the financial health of clients and growth for the company
• Conducts timely and accurate follow-up on professional services claims
• Identifies missing payments from health plans and initiates tracking procedures
• Reviews incoming correspondence from health plans and takes appropriate action
• Identifies pending claims and determines next steps
• Follows up with insurance carriers and providers to gather required information
• Monitors incoming messages from providers and responds or escalates as needed
• Research health plan reimbursement policies and procedures to ensure claims are billed appropriately

Medical Billing Coordinator

Auditor

• Review provider medical records to validate claim data: Codes billed are accurate, complete, and comply with MSO and payer policies
• Codes billed comply with bundling and unbundling guidelines and global period policies
• ICD-10 codes are chosen appropriately and to the highest level of specificity
• CPT and HCPCS codes accurately report the services rendered including level of E&M code in accordance with AMA, CMS, and state-specific coding standards
• Documentation supports billed services under Medicare, Medicaid, and Commercial payer rules
• Identify and report potential coding errors, documentation gaps, or billing inconsistencies that impact reimbursement or compliance
• Collaborate with nurses, medical director, and claims teams to adjudicate/deny claims with coding and/or documentation errors
• Support retrospective and prospective reviews to improve claims accuracy and reduce preventable denials
• Participate in internal audits, education sessions, and process improvement initiatives to enhance coding integrity
• Stay current on updates to CMS regulations, payer billing policies, and industry coding changes
• Protect member and provide confidentiality by adhering to HIPAA and MSO compliance standards

Certified Medical Auditor – Claims Review

Director

• Auditing institutional and/or professional claims according to established policies and procedures.
• Institutional Claims Report Review
• Institutional full medical record review with no DRG change
• Institutional full medical record review with DRG change and letter of explanation
• Professional Claims Report
• Professional Claims Review with Records
• Symkey Review and Support

Director of Claims Audits

Compliance

• Support the Claims Department by assisting with compliance audits, process reviews, and regulatory monitoring.
• Identify compliance risks, track corrective action plans, and support training and reporting efforts.
• Conduct internal claims audits and quality reviews for accuracy and adherence to policies and regulations.
• Support audit scheduling, data collection, and documentation of audit findings.
• Track and monitor corrective action plans and follow-ups for compliance issues.
• Maintain and update claims compliance logs, audit reports, and reference materials.
• Monitor state, federal, and client-specific regulatory requirements.
• Collaborate with Claims and Compliance teams to communicate audit outcomes.
• Assist in preparation of compliance summaries and reports for management review.
• Support training and awareness initiatives on claims compliance requirements.

Claims Compliance Coordinator

IT Support

• Leading and managing the claims compliance audit program for All Care To You (ACTY).
• Overseeing the delegated claims audit process from start to finish.
• Ensuring all audit deliverables are completed accurately, thoroughly, and on time.
• Identifying and monitoring corrective actions for compliance-related findings.
• Collaborating across teams to promote continuous improvement.
• Maintaining ACTY’s audit readiness and strengthening the organization’s overall regulatory compliance posture.
• Developing, implementing, and maintaining audit schedules, methodologies, and tools for health plan–initiated claims audits.
• Reviewing files for inconsistencies and quality assurance.
• Reviewing audit findings to identify trends, root causes, and potential compliance risks.

Compliance Claims Audit Manager

• Conduct retrospective and concurrent audits of claims to verify accuracy of payment, coding, and rate application.
• Review claims for proper application of Division of Financial Responsibility (DOFR), benefit matrix interpretation, and regulatory compliance.
• Validate application of DRG, APC, ASC, and PPS payment methodologies.
• Identify trends and root causes of claim processing errors and recommend corrective actions.
• Assist with preparation of audit findings and reports for management review.
• Support internal quality control by providing feedback and training recommendations.
• Collaborate with the Claims Audit Director to ensure consistent audit methodology and reporting standards.
• Maintain knowledge of current CMS, DMHC, and DHS regulations as well as company policies related to claims adjudication.
• Participate in special projects, focused audits, or process improvement initiatives as assigned.

Claims Auditor

Communications

• Provide administrative support for client meetings and reporting.
• Act as a liaison between ACTY and clients to ensure satisfaction.
• Post client/provider facing reports to SharePoint and/or submission locations.
• Review and alert MSO leadership of client facing report issues.
• Maintain monthly and quarterly meetings with clients and schedule reminders.
• Prepare agendas, minutes, and meeting materials.
• Follow through with post-meeting tasks.
• Communicate client-related changes and updates.
• Provide support to department leaders as needed.
• Collaborate with diverse teams to provide exceptional customer service.

Client Communication Coordinator

Accountant

• Assist with overall Financial operations and financial processes
• Work closely with the Finance Manager to maintain accurate financial records and procedures
• Primary and/or backup for cash deposit function
• Maintain internal controls for handling cash and checks prior to deposit
• Primary and/or backup for journal entry uploads
• Checking and verifying posting reports to ensure accurate general ledger postings
• Organizing and filing journal entries
• Making updates to claims recovery procedures
• Assist with basic financial accounting and processing of check requests
• Work with third party CPA’s on annual audits for ACTY clients
• Prepare and file quarterly financials with the DMHC
• Reconcile monthly capitation payments received by ACTY clients
• Work with Health plans to ensure monthly capitation is received for all eligible members
• Special projects as needed

• Conduct timely and accurate follow up on unpaid insurance claims using insurance portals, secure email, secure chat, and phone calls
• Identify pended claims and determine next steps required to obtain reimbursement for claim
• Use existing queries to review limited new denials for processing errors, appropriately assign a status based on review, correct any internal errors and resubmit claims as necessary
• Follow up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution
• Monitor incoming messages from providers and respond to the provider or escalate the request to the appropriate team member
• Identify claims with more complex issues and escalate them to the appropriate team member for resolution
• Document all interactions and updates in the claims management system
• Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures
• Prepare and submit reports on claim follow-up activities and status updates to management as requested
• Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements
• Attend departmental and company meetings as required
• Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues
• Investigate and resolve discrepancies or issues related to claims processing and payment
• Work with other team members and departments ensure proper claim submission
• Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process
• Participate in training and development opportunities to stay current with best practices and industry trends

Billing Coordinator

Business Intelligence Developer

• Design, develop, maintain, and support data reporting systems including Power BI and SSRS reporting tools and interfaces.
• Work with our team members to gather and assist with the document of requirements using Azure Dev Ops projects and boards.
• Analyze existing systems and programs and recommend new systems or modifications to our reporting infrastructure.
• Participate in the design and development of solutions using SQL.
• Perform data analysis, root cause analysis, test and QA report output prior to handing over to ACTY users or clients.
• Review queries for performance and optimization, making improvements as needed.
• Create and maintain documentation for all development projects.
• Participate in projects as assigned by your manager or director.
• Regularly communicate with management and technical support colleagues.
• Complete assignments within established timelines and work closely with your manager to resolve barriers and communicate any delays.

Power BI Developer

Support Engineer

• Oversee user technical support to end users.
• Oversee and manage helpdesk tickets ensuring SLAs are met.
• Create and maintain department SOPs and documentation.
• Managing system-level administration, including SSO and MFA configuration across multiple platforms.
• Provisioning, endpoint management, and conditional access setup for both employees and external clients.
• Utilizing IT Glue, oversee and manage Inventory Management including licensing.
• Serve as the main company communication liaison for system and/or software upgrades, changes, and maintenance.
• Actively monitor issues across time zones to ensure timely support for all employees.
• Lead and collaborate on cross-functional IT projects: Windows 11 migration for EOL Windows 10 support, Company-wide WIKI build, assisting with company and department builds, Compliance and security alignment through MFA and RBAC auditing, Enabling SSO across platforms, PowerShell scripting, workflow automation, and external guest access provisioning for secure collaboration.