Practice Transformation Specialis

Job Description

About Us

Advanced Management USA empowers independent physicians to succeed in value-based care. We provide the infrastructure, data, and operational expertise to help practices deliver better outcomes at lower costs—without giving up autonomy. Through our ACOs and partnerships, we drive measurable improvements in quality, efficiency, and patient experience.

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.
• Configure and deploy EHR templates, order sets, and CPT II automations to support accurate coding and quality measure capture.
• 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).
• Collaborate with internal ACO teams (Quality, Data Analytics, Network Management) to monitor performance metrics and recommend improvement strategies.
• 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), Certified Risk Adjustment Coder (CRC), or equivalent credential required.
• Experience:

• 3+ years of experience in EMR optimization, clinical documentation improvement, or risk adjustment.

• Proven experience working within ACO, MSSP, or REACHenvironments preferred.

• Hands-on experience with EMR systems such as eClinicalWorks, Athenahealth, Epic, or Allscripts.

• High school diploma or GED required; associate's or bachelor's degree preferred.

• 2+ years of medical coding, billing, or risk adjustment experience.
• Spanish is a plus.
• 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.
• High accuracy and extreme confidentiality a MUST.
• Detailed oriented and very organized.
• Analyze medical records for completeness, schedule time and assignment effectively.
• This position requires 25% travel.

Benefits:

• Pay: $55,000+ commensurate with experience and qualifications
• Comprehensive healthcare coverage, including medical, dental, and vision insurance
• Retirement savings plan with employer matching
• Paid time off and holidays
• Professional development opportunities
• Performance Bonus

Job Type: Fulltime, permanent

Are you ready to lead transformative changes in healthcare? Join our team and be at the forefront of revolutionizing care coordination and consulting. Apply now to seize the opportunity to make a lasting impact on the lives of our clients and communities, contribute to cutting-edge initiatives in value-based care, and grow your career in a dynamic and supportive environment. Together, let's shape the future of healthcare delivery and make a difference that truly matters.

Don't miss out on this exciting opportunity – apply today and let your passion for innovation and excellence shine

Advanced Management USA is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.