About The Auctus Group LLC

Who we are: We’re big on people and culture at the Auctus Group. Our most important role as a company is to provide an amazing working environment for our team. We’ve been work-from-home-warriors since before it was cool. We support (like encourage and fund) continuing education. We match charitable donations. Our whole goal is: work to live not live to work. Oh and we’re weirdos too…we do remote happy hours and have a book club and goofy stuff like that.

Who we’re looking for: Smart, talented, tech-savvy, experienced, go-getter types. You’ll do well if:

• you like a fast-paced environment,
• you thrive with change and development,
• you like giving feedback,
• you’re a team player,
• you love learning/sleuthing,
• you’re big on accountability.

About the role

• Responsible for interpreting and analyzing coded services provided utilizing standardized medical coding ensuring that all claims billed and collected meet all government or funder mandated procedures for accuracy, integrity, and compliance 

• Reviews and is responsible for being familiar with coding to the degree that they can apply/remove modifiers, spot CPT mismatches based on NCCI edits, recognize fee schedule reimbursement structures related to modifiers and CPTs (e.g., CPT XXXXX reimburses Y and Modifier XX reduces reimbursement by Y), as well as recommend changes. This role is not responsible for coding from an operative note although the skillset therein is favored. 

• Submits paper and electronic billing timely to various payers in accordance with contract requirements including corrections, adjustments, rebilling and proper modifications to claims in accordance with documented billing procedures 

• Reviews rejected claims and researches contract guidelines to ensure corrections, adjustments and proper modifications to claims are worked and resolved timely but generally within 48 hours of receipt – taking an actionable step towards payment every month on every claim for their accounts 

• Works in coordination with The Auctus Group team members, to obtain information relevant to rejected or denied claims, account onboarding, training needs and so on. 

  Maintain current working knowledge of all governmental, funder, contractor mandated regulations or payer requirements as it pertains to claims submissions for services provided 

• Provides continuous updates and information to management regarding ongoing errors, payer related issues, registration issues and other controllable QA related activities affecting reimbursement and payment methodology.  More than 2 is a trend.  Trends get escalated to Revenue Cycle Managers and Team Leads weekly. 

• Maintain strict HIPAA requirements for client and patient confidentiality at all times 

  Any other duties as assigned 

Qualifications