About Us
PBACO supports independent physicians with the tools, services and incentives to thrive - without giving up control. We collaborate with like-minded hospital systems and care centers to create a seamless, integrated experience that improves outcomes and lowers costs. You're not just a participant - you're our partner.
Position Overview
The Healthcare Practice Transformation Specialist will serve as a key liaison between physician practices and our organization. This role combines EHR training, clinical documentation review, risk adjustment coding, and billing support. The ideal candidate will be a Certified Professional Coder (CPC) with strong experience in Medicare, risk adjustment, and healthcare analytics.
Key Responsibilities
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Manage and support a physician network to ensure successful EHR integration and troubleshooting.
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Consult with medical practices to analyze workflows, configure EHR systems, and develop customized training plans.
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Train physicians and office staff on EHR best practices, regulatory compliance, and specialty-specific workflows.
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Review clinical documentation and medical records to ensure accurate ICD-10, CPT, and HCPCS coding for risk adjustment and quality gap closure.
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Conduct coding audits and provide education to providers on compliant documentation.
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Monitor payer guidelines and coding updates, especially for Medicare Advantage and accountable care organizations.
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Assist with billing, claims submission, payment posting, and collections as needed.
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Perform financial analysis and reporting using Microsoft Excel (pivot tables, trend analysis).
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Analyze denial reports, identify trends, and recommend corrective actions.
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Support quality improvement initiatives by ensuring accurate coding for chronic conditions.
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Answer patient billing and claims questions in a professional and clear manner.
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Maintain compliance with HIPAA, coding regulations, and company policies.
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Participate in special projects, audits, and continuous process improvement initiatives.
Qualifications
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Certified Professional Coder (CPC) or equivalent certification.
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Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies.
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High school diploma or GED required; associate’s or bachelor’s degree preferred.
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2+ years of medical coding, billing, or risk adjustment experience.
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Proficiency in EHR systems (Athena, eClinicalWorks, or similar) and MS Office Suite (Excel expertise strongly preferred).
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Strong knowledge of ICD-10, CPT, and HCPCS coding and regulatory compliance.
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Excellent communication and training skills for working directly with providers and staff.
This position requires 50-75% local travel and is eligible for standard IRS mileage reimbursement.
