Med-Metrix

General

• Obtain WC/NF information from patients in the hospital
• Assist with both in-house and discharged patients
• Work in an onsite designated client area to meet with and gather information from patients
• Contact patients and screen for WC/NF insurance on cases referred by the client hospital, by phone or in person
• Review and validate insurance information
• Research and verify patient contact information using search engines and hospital computer systems; annotate hospital systems with daily notes
• Research and resolve pending WC/NF issues
• Retrieve information from hospital databases
• Verify insurance coverage through websites or by calling insurance companies
• Update the internal database with completed account work, actions taken to communicate with patients, and account codes
• Obtain and send mail and correspondence to the Supervisor
• Use, protect, and disclose patients’ PHI in accordance with HIPAA standards
• Comply with Information Security and HIPAA policies and procedures
• Limit viewing of PHI to the minimum necessary for assigned duties
• Perform other duties as assigned

Patient Liaison

Collections

• Initiate collection calls daily
• Arrange payments of outstanding balances
• Set up payment plans for parties unable to repay their debt in full
• Send correspondence regarding delinquent accounts
• Provide daily/weekly updates to management
• Contact health insurance carriers
• Manage a large volume of patient accounts per week
• Coordinate with the legal department on skip tracing, asset location, and garnishments
• Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards
• Limit viewing of PHI to the absolute minimum necessary to perform assigned duties
• Perform other duties as assigned

Collections Representative

Backend Engineer

• Analyze, develop, and support SSIS projects for ETL, file transmission, encryption, and archiving
• Design, develop, and maintain database tables, stored procedures, and supporting objects
• Build and support operational reports for the company and clients
• Provide operational support, resolve recurring problems, and identify root causes
• Document database topology, architecture, processes, and procedures
• Develop SQL queries and support ad hoc data requests
• Assist with capacity planning and resource expansion through data aggregation and analysis
• Collaborate with project managers to ensure reports and metrics identify business needs and process-improvement opportunities
• Identify database-platform inefficiencies and provide solutions to management
• Develop time estimates for assigned tasks
• Assist in resolving business and technical problems
• Monitor emerging security threats, perform periodic security reviews, and propose mitigation approaches
• Ensure regulatory compliance, including HIPAA, in data utilization and information access
• Follow Change Management policies and procedures for production changes
• Protect and disclose patients’ protected health information only in accordance with HIPAA standards
• Comply with Information Security and HIPAA policies and procedures
• Limit PHI access to the minimum necessary for assigned duties
• Perform other duties as assigned

SQL Database Developer

Operations

• Implement Med-Metrix’s Suite of Revenue Cycle Technology, including Hospital and Professional Fee Front End Patient Access Workflow, Patient Accounting Workflow, Denials Workflow, and Liability Estimator
• Support project teams during implementation planning, design, configuration, user acceptance testing, training, delivery, and monitoring of AnalytX Technologies
• Participate in client assessment meetings to determine existing workflow processes
• Collaborate with Process Improvement Consultants to develop best-practice design documentation in Visio
• Participate in rollout of Robotic Process Automation and Machine Learning integration add-ons to AnalytX Workflow projects
• Analyze large data sets to identify improvement opportunities and present supporting data to project teams
• Translate Visio documentation into pseudocode for Development and QA teams
• Diagnose application bugs and gather technical documentation while working with Development and QA teams
• Ensure programmed rules and actions match client processes defined during design
• Lead clients through User Acceptance Testing and organize signoff progress through reporting mechanisms
• Prepare customer Super Users to train End Users for Go Live
• Escalate and communicate priorities, successes, and project risks to Project Management and Leadership
• Use, protect, and disclose patients’ protected health information in accordance with HIPAA
• Comply with Information Security and HIPAA policies and procedures
• Limit viewing of PHI to the minimum necessary for assigned duties
• Perform other duties as assigned

Associate Process Improvement Consultant

Business Development Rep

• Identify market potential by qualifying accounts in the assigned territory and through relationships outside the territory
• Initiate the sales process by scheduling appointments, making initial presentations, and understanding account requirements
• Build and maintain an accurate sales pipeline and meeting records using Salesforce
• Close sales by building rapport, explaining product and service capabilities, overcoming objections, and preparing contracts
• Initiate the implementation process for operational hand-off and participate in implementation updates and progress
• Expand sales in existing accounts by introducing new products and services and developing new applications
• Contribute to market strategy by monitoring competitive products and account reactions
• Recommend new products and services by evaluating current product results and identifying unmet needs
• Update job knowledge through educational opportunities and industry events
• Achieve annual quota
• Perform other duties as assigned
• Follow HIPAA and information security requirements when handling protected health information

Regional Vice President, Business Development

Director

• Provide strategic oversight of cash posting, payment reconciliation, unapplied cash, credit balance resolution, patient and insurance refunds, payer recoupments, and related shared services functions
• Establish operational standards, service level expectations, and performance goals across multiple clients and systems
• Ensure accuracy and integrity of payment posting, balancing, reconciliation, and credit management activities
• Develop and maintain financial controls and support audit readiness and regulatory, client, and organizational compliance
• Partner with clients, Revenue Cycle Operations, Finance, Systems, and executive leadership to resolve challenges and improve financial performance and service delivery
• Serve as escalation point for complex cash, reconciliation, credit, refund, and recoupment issues
• Lead and develop managers and operational teams; establish expectations, accountability, collaboration, and continuous improvement
• Support workforce planning, employee development, and succession planning
• Identify and implement workflow redesign, automation, system enhancements, and standardized operating practices
• Establish and monitor KPIs for cash posting, reconciliation, unapplied cash, credit balances, refunds, recoupments, quality, productivity, and client service
• Analyze operational and financial data to identify trends, risks, and improvement opportunities
• Provide executive reporting and actionable recommendations
• Protect and disclose patients’ PHI in accordance with HIPAA standards
• Perform other duties as assigned

Director, Cash & Credits Management

Client Services Representative

• Ensure satisfaction and retention of assigned clients through superior customer service and operational transparency
• Identify and manage initiatives to optimize revenue cycle performance, drive financial outcomes, and exceed contractual obligations
• Build effective relationships with internal operations and leadership, clients, and vendors
• Partner with client executive and operational leaders to drive expected performance outcomes
• Monitor key metrics and documentation to manage client satisfaction and retention
• Initiate and direct plans to improve client and internal profitability and performance
• Follow up on client feedback and issues and track improvement plans
• Serve as liaison between clients and operations
• Identify process improvements and efficiencies related to customer satisfaction
• Conduct typically monthly client reviews
• Act as escalation point and proactively manage and resolve customer issues
• Track progress and opportunities across internal and external teams
• Alert customers to changing services
• Maintain key client relationships to drive performance and minimize attrition
• Ensure key customers are referenceable promoters to support sales
• Develop ad hoc and scheduled operational performance reports, including trend and anomaly insights, for presentation to assigned clients
• Perform other duties as assigned

Client Services Manager

Consultant

• Act as liaison between the data team and customers during implementation of the Med-Metrix Suite of Products and Services
• Work directly with customers through successful implementations using technical and analytical skills
• Plan, coordinate, and implement projects with assigned MMX Data Team members according to defined data specifications
• Identify and minimize project risks through successful project completion
• Create detailed project plans and sequence implementation activities
• Lead conversations with customers, business representatives, and technical representatives regarding data aspects
• Analyze customer-provided inbound account, payment, demographics, and charge files using SQL table structure knowledge
• Create and maintain project documentation, data specifications, diagrams, and process maps
• Troubleshoot data with customers and review QA reports; lead discussions regarding operational impacts when applicable
• Facilitate weekly calls, record meeting minutes, identify next steps, and follow up on open activities
• Review project team work quality against project standards
• Ensure timely, satisfactory, and high-quality project deliverables
• Lead teams during high-priority risk situations across internal and client cross-functional teams
• Escalate critical implementation-related risks and facilitate timely resolution
• Use, protect, and disclose patients' PHI in accordance with HIPAA standards

Data Acquisition Consultant

• Oversee and prioritize the work of the EDI development team
• Ensure client timelines are understood and maintained for new development work
• Coordinate requirements, timelines, technical issues, implementation activities, and operational support with implementation and operations leads
• Participate in client calls as needed
• Oversee EDI Jira instance processes, activities, and access; validate ticket documentation and work queues
• Facilitate CDM design sessions and evaluate approaches based on EHR requirements
• Lead architecture for legacy CDM and extract changes
• Provide technical direction and design guidance for new EDI capabilities
• Maintain and promote department standards and coding practices
• Coordinate Mirth Connect renewal, upgrade planning, and cross-team implementation activities
• Mentor and cross-train EDI team members and coordinate backup coverage
• Represent the EDI team in Agile Scrum planning, backlog discussions, sprint reviews, and management status reporting
• Produce and maintain automated reporting that loads active Jira entities and accounts into Jira Assets for the Product Support Portal
• Produce quarterly Source Authority output for contractual reporting related to licensed third-party data
• Coordinate responses to ad-hoc operational data questions about imports and extracts
• Serve as technical liaison with trading partners and other organizations, including escalated or complex items
• Use, protect, and disclose PHI in accordance with HIPAA standards
• Comply with Information Security and HIPAA policies and procedures
• Limit PHI viewing to the minimum necessary for assigned duties
• Perform other duties as assigned

Director, Data & Integrations – EDI

Physician

• Lead the Physician Advisor team and mentor and teach internal and external stakeholders
• Maintain quality across the Physician Advisor team and manage PAOC client relationships
• Perform case reviews of all case types to achieve a high degree of compliance
• Respond to clinical review requests regarding medical necessity and other case management matters
• Consult with attending physicians, nurses, and case management staff on complex clinical issues, continued stay, medical necessity, and utilization management
• Apply MCG/InterQual criteria and professional judgment to patient-specific situations
• Support case management outcomes and clinical progression of patient care
• Recommend improvements to health record documentation affecting ICD code capture, severity, acuity, mortality risk, and DRG assignment
• Participate in Physician Advisor, Utilization Management, Care Management, and related training and education
• Meet production, quality, and performance standards
• Maintain patient and business confidentiality and comply with HIPAA and information security policies
• Facilitate, mentor, and educate physicians regarding payer requirements
• Attend meetings and participate in peer review as requested
• Manage PAOC client relationships, quarterly reports, and JOCs
• Contribute to PAOC’s quality program and continuous Physician Advisor development
• Educate client-facility staff on relevant topics
• Mentor and train new and existing Physician Advisors
• Serve as Team Lead for Physician Advisor dashboard management when scheduled
• Perform additional duties as assigned

Physician Advisor II

Accounts Receivable

• Monitor and oversee the daily activities of the accounts receivable team, including inventory management and staff training
• Monitor and coordinate follow-up activities to ensure equitable work assignments, timely account follow-up, and achievement of collection goals
• Perform weekly quality assurance reviews of the team’s work
• Review staff productivity reports weekly
• Provide weekly staff productivity updates to the AR Analyst
• Assist with and resolve external and internal client inquiries
• Prepare and maintain reports or logs as required
• Maintain current working knowledge of healthcare-related issues and regulations
• Identify issues and work with the manager and director to resolve them
• Provide training, monitoring, feedback, and disciplinary action as necessary
• Monitor team attendance and PTO usage
• Ensure remote client access is disabled promptly for terminated or transferred employees when applicable
• Ensure direct reports are trained and compliant with Information Security and HIPAA policies and procedures
• Limit viewing of PHI to the minimum necessary to perform assigned duties
• Perform other duties as assigned

Supervisor, Accounts Receivable Services – Hospital Experience

Team Lead

• Train and oversee offshore provider enrollment team members
• Assist the provider enrollment manager with credentialing and enrolling new and established healthcare providers
• Oversee issue resolution for provider education, application completion, and submission
• Ensure collection, updating, and maintenance of provider information and documentation
• Ensure enrollment follow-up with clients and payers is completed within departmental and client parameters
• Complete initial provider enrollment and re-credentialing applications accurately and on time
• Verify provider and group information with insurance companies
• Coordinate provider enrollment and termination information and communicate with teams and clients
• Contribute collaboratively to departmental processes and procedures
• Monitor provider enrollment work queues, smart feeds, and provider reports; communicate opportunities and trends to the Manager
• Organize, schedule, conduct, and document onshore and offshore team training
• Monitor and analyze productivity and perform quality assurance for the offshore team
• Provide timely feedback on quality assurance results
• Identify challenges among offshore staff and provide guidance
• Protect and disclose PHI in accordance with HIPAA standards and comply with Information Security and HIPAA policies

Team Lead, Provider Enrollment

Insurance

• Oversee day-to-day insurance follow-up and billing operations
• Manage and develop operational teams responsible for client delivery
• Monitor operational performance metrics and identify trends, gaps, and improvement opportunities
• Implement and maintain processes and best practices for insurance follow-up, billing, and receivables management
• Partner with leadership and client teams to address operational issues and improve performance
• Monitor client service delivery and maintain relationships with client contacts
• Support operational plans and initiatives aligned with organizational and client goals
• Ensure appropriate staffing and resource allocation
• Improve productivity, efficiency, quality, and financial performance
• Prepare and communicate operational reports, performance results, and recommendations
• Ensure quality standards are understood, followed, and monitored
• Use and protect patients’ PHI in accordance with HIPAA standards
• Perform other duties as assigned

Manager, Insurance Operations – Hospital Experience

Account Manager

• Perform collections, account follow-up, and billing allowance posting for assigned accounts
• Follow up with payers via phone, email, fax, or websites to resolve outstanding claims
• Review and accurately update patient and financial information
• Verify responsible parties and insurance payment information
• Monitor billings for accuracy and correct errors
• Monitor Medicaid/Healthy Options coupons to ensure services are billed within expected timeframes
• Bill hospital services to primary insurers or patients correctly and on time
• Explain hospital payment regulations and maintain knowledge of insurance regulations and hospital contracts
• Identify and report underpayments and denial trends
• Analyze and resolve issues causing payer payment delays and initiate appeals when necessary
• Manipulate Excel spreadsheets and communicate results
• Meet departmental productivity and quality standards
• Maintain confidentiality and comply with HIPAA and information security policies
• Limit access to protected health information to the minimum necessary
• Perform other duties as assigned

Patient Account Representative – Medicare/Medicaid Exp

• Manage collections, account follow-up, and billing allowance posting for assigned accounts
• Follow up with payers by phone, email, fax, or websites to resolve outstanding claims
• Review and accurately update patient and financial information
• Verify the individual or insurance company responsible for payment
• Monitor billings for accuracy and correct known errors
• Monitor Medicaid/Healthy Options coupons and ensure services are billed within expected timeframes
• Bill hospital services correctly to primary insurers or patients
• Explain hospital payment regulations and maintain knowledge of insurance regulations and hospital contracts
• Identify and report underpayments and denial trends
• Analyze and resolve issues causing payer payment delays and initiate appeals when necessary
• Manipulate Excel spreadsheets and communicate results
• Meet daily productivity and quality standards
• Perform special projects and other duties assigned by management
• Maintain confidentiality and protect, use, and disclose PHI in accordance with HIPAA
• Comply with Information Security and HIPAA policies and procedures
• Limit PHI access to the minimum necessary for assigned duties