Medical Billing Coder
4D Healthware provides innovative technology needed to exceed the world of virtual health which includes Remote Patient Monitoring (RPM) Chronic Care Management (CCM) and Telemedicine.
The 4D Healthware Medical Billing Coder will work in a virtual office setting and is to review clinical statements and assign standard codes using CPT, ICD-10-CM, and HCPCS Level II classification systems. Medical classification, or medical coding is the process of translating medical reports into a code used within the healthcare industry. The use of medical codes helps summarize medical services and reports. These medical code sets help medical coders document the condition of a patient and describe the healthcare procedures performed on a patient in response to their condition.
Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider.
- Performs accurate data entry by utilizing computerized abstracting system.
- Meets production and quality standards for number of records coded and abstracted.
- Continually assesses and evaluates clinical edit compliance with CMS and industry standards
- Reads and analyzes Medicare policy including final rulings, daily transmittals, bulletins, policy manual updates and more to begin the cycle of product development/maintenance
- Analyzes, reviews, studies and verifies data as it becomes available from government and other policy agencies. This can be a 1,200 page Medicare rule or revisiting a physician fee schedule (data file) that has been reposted
- Contacts various government entities to clarify new and existing policy
- Develops formal clinical edit criteria within system payment rules and develops payment policy rules
- Acts as a clinical liaison and subject matter expert with internal staff and clients
- Engages existing clients to identify specific functionality requirements
- Suggests and presents claim edits to clients for selection
- Coordinates with developers, QA, and client service team members to ensure that clinical edits are implemented accurately and timely
- Writes requirements
- Develops test claims for UAT and QA
- Develops and maintains a high level of proficiency in the Company’s products (software, data) and services (advisory, analytic, training/education), including commercial contracting features as related to the specific area(s) assigned
- Develops and delivers internal and external educational presentations related to Medicare/Medicaid reimbursement or commercial contracting features
Education and Experience Required
- Extensive background of ICD-10 and CPT coding principles
- Extensive knowledge of medical claim editing (NCCI, etc.)
- Knowledge of industry standard payment rules and methods
- Recognized prior expertise in claims processing, payment policy, or contracting
- AHIMA, AAPC or other nationally recognized coding certification [Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification], preferred
- Excellent Communication Skills
- Self-motivated with the ability to work independently and in a team environment
- Critical (analytic) thinking, looking into logic-based details while problem-solving for the overall big picture
- Professional poise: ability to credibly interact with and educate various internal and external groups and individuals (colleagues, clients, industry groups), about effective coding and billing.
- Minimum of 1 year experience in Telemedicine and Remote Patient Monitoring Sector
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Vice President of Technology and Innovation
4D Healthware is on a mission. We empower patients to better self-manage chronic conditions by giving them the tools and support they need at home.
Our delivery model serves health plan members, contributing to higher star rankings and lower healthcare costs. We manage our patients’ complex and chronic needs from where it matters most – at home. Care provided in the home helps promote quality of life, improved health for our patients and supports the family unit, ultimately resulting in low hospital re-admission rates and reduced costs for Health plans. Our “Virtual Clinic” includes care management, telehealth and revenue cycle management and services clients of various health systems.
The Vice President of Technology and Innovation ensures the development and implementation of innovative, quality, and scalable cost-effective solutions to meet current and future needs of the company. This leader will need to be both doer and delegator, able to grow an experienced team capable of delivering day-to-day product development activities, while also providing strategic thought leadership and planning. This leader must be comfortable diving into technical details to solve challenges but also able to interpret the significance of those details as they relate to business operations and communicate the risks to the Company’s executive leadership.
This position fundamentally leads the strategy that drives our modern software development team by taking an active role in planning and facilitation to achieve our committed outcomes. This position requires solid, practical experience with Agile techniques and approaches to guide, support and improve product teams. You will collaborate intensively with your team members and product owners.
The complexity of this position requires a leadership approach that is engaging, imaginative, and collaborative, with a sophisticated ability to develop scalable, supportable, maintainable, robust, and high performing solutions that meet our own internal requirements which incorporate our client’s needs and requirements.
Required Skills and Experience:
- Bachelors or advanced degree in Computer Science, Math, or other engineering discipline.
- Minimum of 10 years of relevant experience.
- Hybrid Solutions Engineering and Solutions Architect background. Understanding of healthcare service delivery end to end. Developing requirements for new functionality, redesigning existing applications and/or exploiting existing tools to add new features supporting team services, optimize, scale or improve stability and performance.
- Developing distributed architectures involving a number of external interfaces.
- Developing and managing the security accreditation documentation.
- Agile Scrum for software development (Agile Framework) to include sprint cycle to track all tasks and user stories.
- Utilizing GitHub in support of code management.
- Architecting and developing database designs leveraging relational databases such as Oracle and SQL Server Demonstrated Recent (past 2 years).
- AWS and/or Cloud Computing SQL Windows, and Linux operating systems Software/Database Development DevOps environment and promoting applications from one environment to another.
- Developing Angular user interfaces Java development using Spring and Hibernate.
- Developing and consuming REST web services and integrating them with SQL backend such as Oracle.
- Deploying and maintaining redundant applications hosted in Linux and using Apache with AWS Desired Skills.
- Developing wireframes and other mockups to conceptualize user interface and user experience.
- Certified in Scrum / Kanban / SAFe such as CSM or PSM or SAFe SM – At least one Scrum Certification required from Scrum Alliance, Scrum.org, Scruminc.com or SAFe.
- Exemplifies and promotes and applies Agile values and principles.
- Outstanding communication, facilitation, negotiation and coaching skills.
- Experienced with Agile Lifecycle management tools and Miro or Visio.
The Vice President of Technology and Innovation will be responsible for:
- Oversees the strategy of the Product Development department, to implement company-level continuous technological evolution, through the use of data analytics, streamlining and integrating disparate systems, establishing core metrics/KPIs, and instituting development standards and best practices.
- Oversees the preparation and final approval of project plans.
- Conducts or acquires cost analysis for development projects; prepares or delegates preparation of schedule of project completion dates.
- Ensures that projects are completed within budget and in an economical manner.
- Establishes and implements the strategic direction of the company’s engineering and development initiatives.
- Collaborates with the company’s executive leadership to develop and meet organizational goals while supplying expertise and guidance on projects, operations, and systems.
- Identifies, recommends, and implements new technologies and systems to improve organizational processes and decision-making.
- Ensures that departmental decisions such as staffing, development, organization, hardware acquisitions, and facilities are in line with the organizations business plan and vision.
- Establishes, communicates, and implements engineering and development policies, practices, standards, and security measures to ensure effective and consistent operations.
- Maintains knowledge of emerging technologies and trends in engineering and development related to the organizations industry.
- Negotiates cost-effective contracts for the organization; coordinates and implements contractors work, and resolves any disputes over labor, scheduling, or payments.
- Performs other duties as assigned.
We are building the future of healthcare delivery. Join us!
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Medical Device Specialist
The Medical Device Specialist assists in scheduling, enrolling, and supporting patients that are equipped with a medical device to manage their chronic conditions and improve health outcomes & quality of life.
As a RPM Medical Specialist you will:
- Excel in a fast-paced, metrics-driven, entrepreneurial, and challenging environment.
- Develop strong, transferable business skills – including client service excellence, written and oral communication, client and account management, time management, problem solving, and project management.
- Understand and deploy a broad range of medical device products to creatively support clients.
- Collaborate with colleagues on and across teams to build and shape a business.
- Clinical support and patient care of chronic disease device patients
- Clinical knowledge of all manufacturer’s devices and therapies required
- Typically, a set work schedule (travel required, as needed)
- Does full evaluation and assessment of patient’s abilities; Reprograms devices as required.
- Enrolls, interrogates and programs patients with devices and recognizes abnormalities, malfunctions and alert indicators.
- Assists in scheduling patients for follow up, remote monitoring, or replacement as indicated.
- Coordinates and prioritizes with other members of the healthcare team to respond to patients, plan, and initiate timely and efficient care.
- Educates patients and families regarding device function and remote and / or clinic follow up scheduling.
- Assists with device management/tracking system and/or supply chain.
- Ensures timely and proper documentation for billing.
- Participates in the device recall, if necessary.
- Supports all aspects of documentation in the care management reporting system.
- Is available to perform duties in satellite and affiliate device clinics as needed.
Education and Experience:
- High School Diploma/Medical Assistant Certification or transferable work experience
- Demonstrated experience in a healthcare or related field
- Strong interest in developing the skills to excel at client service in a high-volume environment
- Excellent communication (oral and written) and interpersonal skills
- Ability to work responsibly, both independently and collaboratively, in an ever-changing, and fast-paced environment
- Attention to detail and strong problem-solving skills
- Receptive to close coaching and feedback
- Desire to learn about trending healthcare topics
- Desired, but not required: Relevant experience working in medical device, life sciences, or healthcare technology sector
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