If you are interested in joining the SunStone Consulting team, please send your resume and the position your are applying for to inquiries@sunstoneconsulting.com.
Current Openings
Professional/Outpatient Senior Consultant
Senior-level professional with in-depth professional or hospital outpatient documentation, coding, and billing auditing experience within a workplace culture that emphasizes open communication and opportunities for growth. Must be highly organized and possess professional or outpatient coding certifications with specific experience reviewing documentation, coding and billing of physician charges. The ideal candidate can work independently in a home office setting, is a problem-solver and effective communicator, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment.
Responsibilities:
Utilizing their knowledge of professional and/or outpatient coding, conducts compliance related documentation, coding, and billing audits to identify coding and/or clinical documentation improvement opportunities using professional coding standards and regulatory guidance.
Applies comprehensive knowledge of Medicare and Medicaid guidelines under the Medicare Physician Fee Schedule, Conditions of Participation, state healthcare regulations, and official coding guidelines for ICD-10-CM and CPT to compliance audits.
Demonstrates expertise in utilizing regulatory coding resources such as AMA E/M guidelines, CPT Assistant, NCCI, and Coding Clinics relative to physician charges.
Prepares accurate and thorough claim review finding workpapers, with notation of regulatory documentation references utilized to support findings during the audit, while also maintaining greater than 95% accuracy of physician charges.
Demonstrates an ability to collaborate well with others on the review team, sharing insights and uncovering opportunities and/or compliance risk.
Conducts research surrounding governmental or third-party payer guidelines by evaluating applicable coding guidelines, LCD’s, NCD’s and any applicable CMS or payer guidelines. Ability to articulate research findings in a cohesive, well written manner for ease of client interpretation.
Assists with the development of educational material and conducts education with clients on clinical documentation and professional and technical charge capture and coding opportunities, to include practitioners, clinical staff, allied health professionals and coders.
Conducts reviews to assess the accuracy of professional and technical CDM for services requiring CPT/HCPCS codes, to include compliance with governmental guidelines and regulations.
Qualifications:
Bachelor’s degree with a minimum of 10+ years of multi-entity health information and/or clinical/auditing experience of physician and outpatient technical billing.
Certified Procedural Coder (CPC) or Certified Outpatient Coding (COC) or Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) or Registered Nurse (RN).
Knowledge of anatomy, physiology and medical terminology commensurate with the ability to correctly code various types of and diagnoses.
Ability to communicate and collaborate effectively with managers, clients, and team members.
Demonstrates independent judgment, discretion, accuracy, analytical skills and decision-making abilities.
Proficient in Microsoft Office Suite including Word, Excel, PowerPoint, SharePoint and e-mail application.
Senior Clinical Specialist
Seeking an individual with in-depth expertise with professional and outpatient facility documentation, coding and billing audits, within a workplace culture which emphasizes open communication and opportunities for growth. Must be highly organized and possess a nursing and/or other clinical degree, clinical expertise, and at least one coding certification. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment.
Responsibilities:
Assist management with the development of the Audit Approach for projects that aligns with the Scope of Services for the specific client engagement.
Assist with and provides clinical oversight and coding support to consulting team during documentation, coding and billing reviews.
Performs quality review of consultant’s findings and assists Senior Managers in the preparation of observations and recommendations for reporting purposes based on regulatory references and overarching claim review findings.
Applies comprehensive knowledge of Medicare and Medicaid guidelines, Conditions of Participation, state healthcare regulations, and official coding guidelines for ICD-10-CM and CPT to compliance audits. Demonstrates expertise in utilizing regulatory coding resources such as AMA E/M guidelines, CPT Assistant, NCCI, and Coding Clinics.
Assist with governmental or third-party payer denials by evaluating compliance with coding guidelines, LCD’s, NCD’s and any applicable CMS or managed care payer guidelines.
Conducts research surrounding governmental or third-party payer guidelines by evaluating applicable coding guidelines, LCD’s, NCD’s and any applicable CMS or payer guidelines. Ability to articulate research findings in a cohesive, well written manner for ease of client interpretation.
Demonstrated proficiency in preparing accurate and thorough work papers related to audit findings, with clinically credible documentation references to support findings.
Develops education material and facitliates education with clients on clinical documentation and coding opportunities, to include practitioners, clinical staff, allied health professionals and coders.
Qualifications:
Bachelor of Science Degree in Nursing (BSN) and/or Current licensure as a Registered Professional Nurse; BSN preferred (other clinical degrees can be considered).
Certified Procedural Coder (CPC), Certified Outpatient Coding (COC), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).
Clinical experience as well as a minimum of 10+ years of multi-entity health information and/or clinical/coding experience.
Strong clinical background with knowledge of anatomy, physiology and medical terminology commensurate with the ability to correctly code various types of services and diagnoses.
Ability to communicate and collaborate effectively with managers, clients and team members.
Demonstrates independent judgment, discretion, accuracy, analytical skills and decision-making abilities.
Proficient in Microsoft Office Suite including Word, Excel and e-mail application.
Medical Claims Specialist
A medical claims specialist is responsible for submitting medical claims to insurance companies for payment to the medical provider for services rendered. Our immediate need is for Medical Claims Specialists for our Pennsylvania Workers’ Compensation and Auto billing and collection outsourcing practice.
The general responsibilities of the Medical Claims Specialist include:
verifying patients’ employer and workers’ compensation/auto insurance coverage,
confirming that all required data elements have been completed on the claim forms,
compiling all the necessary documents to submit a medical claim, including the UB04 claim form, detailed bill, relevant sections of the patient’s medical record and the medical report form.
ability to work with insurance adjusters and other personnel to expedite medical claim payments.
discuss underpayments with insurance companies and resolving those underpayments.
file an Application for Fee Review with the Pennsylvania Bureau of Workers’ Compensation for any disputes that cannot be resolved directly with the insurance company.
document the patients account in the medical providers system to reflect all updates and conversations with insurance companies.
The candidate should have solid time management and documentation skills and be a detail-oriented person. Also, an understanding of HIPPA and PHI guidelines, excellent customer service skills and telephone skills, and be familiar medical terminology and medical insurance codes. Familiarity with Microsoft Office products is required, especially Microsoft Word and Excel. Location is in the Newtown Square, PA area.
Prior experience a plus but not required.
Job Type: Full-time
Medical Billing Supervisor
Overview: We are seeking a qualified and dedicated medical biller/analyst to join our reimbursement and revenue consulting practice
Job Type: Full-time
Job Description
This person will be responsible for a variety of tasks requiring data analysis, evaluation, and judgment. To succeed in this position, the candidate must possess a working knowledge of billing software, medical insurance contracts, and be able to demonstrate excellent written and verbal communication skills. Communication with other consulting team members, clients, and insurance representatives will form a large part of the day to day functions. Primary duties for this position will include the following:
Working with various billing software applications
Submitting Medicare and managed care claims and adjustment claims
Tracking insurer payments and analyzing contractual allowances
Pursuing denied claims through electronic and written appeal
Conducting follow-up and resolution with insurers
Performing medical record analysis
Analyzing patient benefit eligibility information
Desired Experience
A minimum of five years of experience as a medical inpatient biller in a high-volume healthcare setting. Strong desire for supervisory experience
Thorough understanding of Medicare and managed care insurer billing, reimbursement and terminology
Proficient with Microsoft Office products including Excel and Teams
Familiarity with Medicare DDE/FSS0/HETS systems
EPIC and/or other third-party billing systems
Must have the ability to work independently, mentor others and manage time effectively