Medical Coding & Billing Professional

Company Description:

Quartet is a leading tech-enabled behavioral health company that works with health plans, systems, and provider groups to deliver speed to quality behavioral health care for all. Through sophisticated data and analytics, along with personalized services, Quartet exists to advance quality care as defined by four measures: speed to care, seamless patient experiences, improved health outcomes, and affordability. The company is backed by venture funding from top investors including Oak HC/FT, GV (formerly Google Ventures), F-Prime Capital Partners, Polaris Partners, Deerfield Management, Echo Health Ventures, Centene Corporation, and Independence Health Group.

Our ideal candidate will possess the skills and abilities to complete the following:

Role Responsibilities:

• Assign appropriate ICD-10, CPT, and HCPCS codes to diagnoses, procedures, and services rendered by healthcare providers
• Upholds compliance with Federal, State, County laws and regulations related to coding and billing for Risk Adjustment reviews of patient records
• Review medical records and documentation to accurately assign codes and ensure compliance with coding guidelines and regulations
• Conduct regular audits to identify coding errors and discrepancies and implement corrective measures as needed
• Collaborate with healthcare providers and billing staff to optimize revenue cycle management processes
• Ensure timely and accurate submission of coded claims across multiple lines of business to insurance companies and government payors (FFS, $0 claims, etc.)
• Monitor claim denials and rejections, investigate discrepancies, and facilitate resolution to ensure maximum reimbursement
• Provide feedback and education to healthcare providers and staff on documentation improvement opportunities to support accurate coding and billing practices
• Stay updated on changes in coding guidelines, regulations, and reimbursement policies and communicate updates to relevant stakeholders
• Perform quality assurance reviews of coded medical records to ensure compliance with coding standards and accuracy in code assignment
• Collaborate with compliance and auditing teams to address coding-related issues and implement best practices for quality improvement
• Support month-end and ad hoc financial and reporting activities

Required Qualifications:

• Certified Coding Specialist (CCS), Certified Risk Coder (CRC), or equivalent coding certification from an accredited coding program (AAPC or AHIMA) required
• Certified Professional Billing (CPB) certification desirable 
• Minimum of at least 4 years of experience in risk adjustment coding
• Minimum of 4 years of experience in medical coding and billing, with a focus on ICD-10, CPT, and HCPCS coding systems
• Proficiency in medical terminology, anatomy, …