MicroHealth

Developer Relations

• support Software Development Services team
• provide software engineering and development expertise
• perform system development life cycle (SDLC) tasks
• business process orchestration/mapping
• upper and lower-level environment design
• build and deploy custom Services, Adapters, and Protocols
• assist in the configuration of IBM Sterling Middleware software products
• participate as an active member of the scrum team
• produce quality and timely deliverables
• provide input to Software Design Document (SwDD)

ITX Developer, IBM Sterling, EDI, SAFe

Revenue Operations

• Oversee complex, multi-faceted revenue cycle programs from end to end
• Apply formal project management methodologies (Agile, Waterfall, Hybrid) to manage scope, timelines, budgets, and risks across complex front-, middle-, and back-end revenue cycle programs
• Lead cross-functional teams including clinical staff, billing specialists, IT professionals, and executive stakeholders
• Develop comprehensive project charters, work breakdown structures, and communication plans
• Monitor project milestones and deliverables, ensuring alignment with organizational strategic goals
• Manage and report on Service Level Agreements (SLAs), ensuring compliance with contractual obligations and performance metrics
• Identify operational bottlenecks and inefficiencies across the revenue cycle continuum
• Design and implement standardized workflows to increase efficiency and reduce errors
• Deploy automation solutions to streamline repetitive tasks and improve accuracy
• Conduct process mapping and gap analysis to identify improvement opportunities
• Champion change management initiatives to ensure successful adoption of new processes
• Analyze claim rejection and denial trends to identify root causes and systemic issues
• Direct targeted strategies to improve clean claim rates and accelerate reimbursement cycles
• Collaborate with coding and billing teams to address documentation deficiencies
• Implement denial prevention programs and appeal processes
• Monitor payer-specific requirements and adjust workflows accordingly
• Track and report on core Key Performance Indicators (KPIs) including: Days in Accounts Receivable (A/R), Net collection rates, Clean claim rates, Denial rates and appeal success rates, Point-of-service collections, Cost-to-collect ratios
• Generate routine executive reports and dashboards for senior leadership
• Develop comprehensive reporting frameworks to support data-driven decision-making
• Conduct variance analysis and recommend corrective actions
• Present findings and recommendations to C-suite executives and board members
• Act as a strategic liaison between clinical, financial, and IT departments
• Facilitate regular meetings with stakeholders to ensure alignment on revenue goals
• Translate complex financial and technical concepts for diverse audiences
• Build consensus among competing priorities and resource constraints
• Maintain transparent communication channels with all project participants
• Ensure all billing and coding practices adhere to federal, state, and payer regulations
• Stay current on regulatory changes including CMS guidelines, HIPAA requirements, and payer policies
• Oversee internal and external auditing processes to ensure compliance and accuracy
• Coordinate with compliance officers to address audit findings and implement corrective action plans
• Develop and maintain compliance documentation and standard operating procedures
• Apply certification knowledge in coding, billing, and auditing to ensure best practices
• Demonstrate proficiency with Careview and InnovAlone platforms
• Optimize Electronic Health Record (EHR) system configurations to support revenue cycle workflows
• Collaborate with IT teams on system implementations, upgrades, and integrations
• Exhibit strong system savvy to quickly learn and adapt to new technologies and platforms
• Evaluate and recommend revenue cycle management software and tools
• Ensure data integrity across multiple systems and platforms

Senior Revenue Cycle Management Project Manager – Systems, Reporting, SLA Experience

Frontend Engineer

• Assign accurate and compliant ICD-10-CM diagnosis codes for inpatient encounters
• Assign accurate and compliant ICD-10-PCS procedure codes
• Review physician documentation for completeness and accuracy
• Identify complications and comorbidities (CC/MCC) to ensure appropriate DRG assignment
• Query physicians for documentation clarification when necessary to support accurate coding
• Ensure compliance with all applicable coding guidelines including Official Guidelines for Coding and Reporting
• Assign accurate CPT/HCPCS codes for outpatient services
• Assign accurate ICD-10-CM diagnosis codes for outpatient encounters
• Perform APC assignment for outpatient services
• Code observation services in compliance with CMS guidelines
• Code emergency department encounters with appropriate E/M levels
• Code same-day surgery procedures
• Code outpatient diagnostic services (radiology, laboratory, cardiology, etc.)
• Review encounter/charge data for completeness prior to claim submission
• Prepare UB-04/837I institutional claims and CMS-1500/837P professional claims
• Validate all coding assignments and charges against documentation
• Validate critical data elements including: Member/patient identification numbers, National Provider Identifier (NPI) numbers, Provider taxonomy codes, Procedure modifiers, Units of service, Attending and operating provider information
• Verify compliance with payer-specific rules and requirements
• Perform claims formatting and compliance checks
• Submit claims electronically through designated clearinghouse or billing system
• Ensure timely electronic submission of claims within 48-72 hours of receiving complete information
• Monitor claim acceptance or rejection status
• Correct and resubmit rejected claims within 48 hours of notification
• Maintain compliance with payer filing limits and timely filing deadlines
• Manage clearinghouse transactions and resolve transmission issues
• Review and analyze claim denials and rejections
• Identify root causes of denials (coding errors, documentation deficiencies, registration issues, etc.)
• Correct coding or billing errors and resubmit claims
• Prepare appeals with supporting documentation when appropriate
• Track denial trends and recommend process improvements
• Work collaboratively with clinical documentation improvement (CDI) staff to address documentation issues
• Maintain 95% patient billing accuracy rate
• Ensure all coding and billing activities comply with: CMS regulations and guidelines, Medicare and Medicaid billing requirements, NCCI edits and bundling rules, Payer-specific policies and guidelines, HIPAA Privacy and Security Rules, HITECH Act requirements, GMHA privacy and security policies
• Participate in coding audits and quality assurance reviews
• Stay current with coding updates, regulatory changes, and payer policy modifications
• Complete continuing education requirements to maintain certifications
• Document all coding decisions, queries, and claim corrections
• Communicate effectively with physicians, clinical staff, and revenue cycle team members
• Provide coding education and guidance to clinical staff as needed
• Participate in team meetings and case reviews
• Maintain accurate records of work performed and productivity metrics

ITX Developer, IBM Sterling, EDI, SAFe

Senior Revenue Cycle Management Project Manager – Systems, Reporting, SLA Experience

Medical Billing, Coding and Denial Specialist