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Healthcare Practice Transformation Specialist
Healthcare Practice Transformation SpecialistPBACO Holding LLC • Philadelphia, PA, US
Healthcare Practice Transformation Specialist

Healthcare Practice Transformation Specialist

PBACO Holding LLC • Philadelphia, PA, US
30+ days ago
Job type
  • Full-time
Job description

Job Description

Job Description

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

  • Manage and support a physician network to ensure successful EHR integration and troubleshooting.
  • Consult with medical practices to analyze workflows, configure EHR systems, and develop customized training plans.
  • Train physicians and office staff on EHR best practices, regulatory compliance, and specialty-specific workflows.
  • Review clinical documentation and medical records to ensure accurate ICD-10, CPT, and HCPCS coding for risk adjustment and quality gap closure.
  • Conduct coding audits and provide education to providers on compliant documentation.
  • Monitor payer guidelines and coding updates, especially for Medicare Advantage and accountable care organizations.
  • Assist with billing, claims submission, payment posting, and collections as needed.
  • Perform financial analysis and reporting using Microsoft Excel (pivot tables, trend analysis).
  • Analyze denial reports, identify trends, and recommend corrective actions.
  • Support quality improvement initiatives by ensuring accurate coding for chronic conditions.
  • Answer patient billing and claims questions in a professional and clear manner.
  • Maintain compliance with HIPAA, coding regulations, and company policies.
  • Participate in special projects, audits, and continuous process improvement initiatives.

Qualifications

  • Certified Professional Coder (CPC) or equivalent certification.
  • Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies.
  • High school diploma or GED required; associate’s or bachelor’s degree preferred.
  • 2+ years of medical coding, billing, or risk adjustment experience.
  • Proficiency in EHR systems (Athena, eClinicalWorks, or similar) and MS Office Suite (Excel expertise strongly preferred).
  • Strong knowledge of ICD-10, CPT, and HCPCS coding and regulatory compliance.
  • Excellent communication and training skills for working directly with providers and staff.
  • This position requires 50-75% local travel and is eligible for a car allowance.

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