Med-Metrix

Physician

• Perform case reviews of all case types to achieve the highest degree of compliance
• Collaborate with medical staff leadership, physicians, residents, resource management, case management, social services, discharge planning, and utilization management
• Recommend methods to optimize hospital service use, length of stay, resource management, level of care, documentation, coding, and compliance
• Respond promptly to clinical review assistance requests from Case Management
• Consult with attendings, nurses, and case management staff on complex clinical issues, continued-stay justification, medical necessity, and utilization management
• Apply MCG/InterQual criteria, professional judgment, and patient-specific variables
• Support case management outcomes and clinical progression of patient care
• Improve health record documentation affecting ICD code assignment, severity, acuity, risk of mortality, and DRG assignment
• Participate in ongoing Physician Advisor training and education
• Meet productivity, quality, and performance standards and goals
• Maintain confidentiality and comply with HIPAA and information security policies
• Facilitate, mentor, and educate physicians regarding payer requirements
• Attend meetings requested by PAOC leadership
• Participate in peer review as necessary or requested
• Maintain medical licensure and board certification in good standing
• Perform other duties as assigned

Physician Advisor

Product Manager

• Support enhancements to denial classification and root-cause analysis across the denial and appeal lifecycle
• Track and report Denials AI KPIs, including denial overturn rate, submission rate, denial-to-submission turnaround, and dollars recovered
• Support requirements for FHIR/HL7 data ingestion, EMR retrieval, and case creation on denial receipt
• Partner with Data and Engineering to ensure claim, EOB, and coverage data are available for downstream models
• Contribute to product vision, strategy, prioritization, and continuous product improvement
• Support stakeholder communication through status updates, documentation, roadmap priorities, release impacts, and performance outcomes
• Support workflow standardization and configurable pathways for client, payer, and regulatory requirements
• Collaborate with client-facing and delivery teams on workflow adoption, change management, and continuous improvement
• Maintain the product roadmap and track feature progress against defined goals
• Define and prioritize product features under Product Manager guidance
• Translate roadmap features into product requirements, user stories, acceptance criteria, and supporting documentation
• Support Scrum activities including backlog grooming, sprint planning, standups, and sprint-progress tracking
• Identify and escalate risks and blockers affecting release and sprint goals
• Support product demos, UAT, and feedback collection
• Protect and use patients’ PHI in accordance with HIPAA
• Comply with Information Security and HIPAA policies and procedures
• Limit PHI viewing to the minimum necessary for assigned duties
• Perform other duties as assigned

Associate Product Manager – Denials AI

Data Engineer

• Collaborate with the Team Lead and cross-functional teams to gather and refine data requirements for Denials AI solutions
• Design, implement, and optimize ETL/ELT pipelines using Python, Dagster, DBT, and AWS data services
• Develop and maintain PostgreSQL data models; write efficient SQL for querying and performance tuning
• Monitor pipeline health and performance; troubleshoot data incidents and implement preventive measures
• Enforce data quality and governance standards, including HIPAA compliance for PHI handling
• Conduct code reviews, share best practices, and mentor junior data engineers
• Automate deployment and monitoring tasks using infrastructure-as-code and AWS CloudWatch metrics and alarms
• Document data workflows, schemas, and operational runbooks
• Respond to on-call data pipeline incidents
• Use, protect, and disclose PHI in accordance with HIPAA standards; comply with Information Security and HIPAA policies

Senior Data Engineer

Analyst

• Maintain the proprietary pricing transparency tool to ensure compliance with current regulations and code sets
• Audit price index results after data parsing and work with the development team to resolve data issues
• Create client-friendly price index reports after confirming data integrity
• Evaluate and participate in future product enhancements, define acceptance criteria, and translate user requirements into logical designs meeting compliance requirements
• Test development work for accuracy and consistency with product specifications
• Answer product questions from project management, implementation consultants, marketing, sales teams, and clients
• Attend virtual client meetings to review files and address questions about client datasets
• Monitor evolving regulatory requirements and code changes and apply them to maintain product integrity
• Support other departments with industry expertise to optimize client experience
• Use, protect, and disclose PHI 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

Hospital Price Transparency Analyst

Representative

• Follow up with payers via phone, email, fax, or websites to ensure timely resolution of outstanding claims
• Perform payment variance analysis to identify trends in underpaid claims
• Identify and report underpayments and denial trends
• Initiate appeals when necessary
• Interact cooperatively and courteously with patients, visitors, coworkers, management, and clients
• Maintain confidentiality and a professional attitude
• 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 to perform assigned duties
• Perform other duties as assigned

Payment Variance Follow Up Representative

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 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 required reports and logs
• 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
• Maintain professionalism and confidentiality
• Monitor team attendance and PTO usage
• Disable remote client access for terminated or transferred employees when applicable and in a timely manner
• Comply with Information Security and HIPAA policies and procedures and ensure direct reports are trained and compliant
• Use, protect, and disclose patients’ PHI only in accordance with HIPAA standards
• Limit viewing of PHI to the minimum necessary to perform assigned duties
• Perform other duties as assigned

Supervisor, Accounts Receivable Services

• Monitor and oversee the daily activities of the accounts receivable team
• Manage AR operations, staff training, client relationships, and collection goals
• Monitor client inventory, account timeliness, accuracy, quality, productivity, and equitable work assignments
• Ensure supervisors conduct timely and accurate productivity and quality monitoring
• Ensure client-specific policies and procedures are documented and followed
• Provide assistance and resolution for external and internal client inquiries
• Prepare and maintain reports and logs, including monthly client reporting
• Monitor Smartfeed assignments in the MPower Workflow system and escalate issues to leadership and Customer Support
• Review contract pricing and escalate issues to the director and contract management team
• Maintain current knowledge of healthcare issues and regulations
• Provide training, monitoring, feedback, and disciplinary action as necessary
• Monitor team attendance and PTO usage
• Disable remote client access for terminated or transferred employees when applicable
• Ensure direct reports are trained and compliant with Information Security and HIPAA policies
• Report security or HIPAA violations and concerns to the HIPAA Officers
• Perform other duties assigned by management