Contract Medical Billing & Coding Consultant

Stellar Health is seeking a Billing and Coding Consultant with Medicare, ACA (inclusive of ACO) risk adjustment expertise to support value-based care efforts on a part time/contract basis. Responsibilities include training internal staff and medical group stakeholders (executives to billing staff) on accurate coding (ICD-10 and CPTII), claims submission, payer rules (Medicare, Medicaid, commercial), and HIPAA compliance, with a primary care focus. Strong communication, organizational, and problem-solving skills are needed. Deliverables include one-pagers, decks, consultation, executive meetings, and educational sessions. The contractor will investigate and develop comprehensive training materials with examples, and then instruct diverse medical group personnel (medical assistants, office managers, physicians, billers) on accurate diagnosis communication and documentation.

Role Stakeholders:

• Internal Stellar Staff engaged in value-based care initiatives involving providers and payers.
• Medical Group Stakeholders encompassing executive leadership such as CFO/CMO, administrative personnel including office managers, physicians, Medical Assistants, and billing staff.

Preferred Qualifications:

• In-depth knowledge of Medicare and ACA risk adjustment methodologies, reporting, and their implications.
• Proven ability to provide training and education on:
  • Precise Code Assignment: Translating patient diagnoses, procedures, and services into the correct ICD-10, CPT, and HCPCS codes, minimizing errors.
  • Staying Abreast of Updates: Continuously monitoring and implementing changes in coding guidelines, regulations, and payer policies (e.g., Medicare, Medicaid, commercial insurers).
  • Documentation Review: Identifying potential documentation gaps, and collaborating with clinical staff for clarification.
  • Compliance Adherence: Ensuring all coding practices adhere to federal, state, and local regulations, mitigating the risk of audits and penalties.
  • Claim submission support includes identifying and helping to correct common issues related to the full submission of diagnosis codes. This assistance supports the preparation of clean electronic claims for insurance payers by ensuring adherence to specific payer requirements and formats.
• Accurate and Compliant Coding Guidelines:
• General Claims Information

Required Skills and Experience:

• Over 7 years of experience in primary care billing and coding.
• Comprehensive knowledge of payer regulations, including Medicare, Medicaid, and commercial plans.
• Thorough understanding of HIPAA compliance requirements.
• Soft skills: Attention to detail, strong communication skills and ability to refine messaging to executive and junior audiences, and problem-solving abilities..
• Strong organizational skills are crucial for success in this role. These skills encompass the ability to effectively manage time, prioritize tasks, maintain accurate records, and adhere to established procedures. Attention to detail and a systematic approach to work are also integral components of strong organizational abilities, ensuring efficiency and accuracy in all responsibilities.

Term and Contract Rate:

This part time contract role is for a six month term and for five to ten hours per week. The contract rate is between $125 - $275 per hour. Actual contracted rate will be based on the level of experience of the contractor.