Healthcare Practice Transformation Specialist

Palm Beach Accountable Care Organization; Hackettstown (NJ); On-site; USD 70,000 - 95,000; Full time

Job summary

Palm Beach Accountable Care Organization is seeking a Healthcare Practice Transformation Specialist to serve as a liaison between physician practices and our organization. The role combines EHR training, clinical documentation review, risk adjustment coding, and billing support.

The ideal candidate is a CPC with strong Medicare risk adjustment experience and healthcare analytics expertise, and will travel locally (50-75%).

Qualifications

• Certified Professional Coder (CPC) or equivalent certification.
• Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies.
• High school diploma or GED required; associate’s or bachelor’s degree preferred.
• 2+ years of medical coding, billing, or risk adjustment experience.
• 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.

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.
• 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).
• 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.

Skills

CPC certification

Medicare Advantage experience

Risk adjustment

EHR training

Data analysis

Communication skills

Education

High school diploma or GED

Associate degree preferred

Bachelor’s degree preferred

Tools

Athena

eClinicalWorks

Excel

Pivot tables

Job description

PBACO supports independent physicians with the tools, services and incentives to thrive - without giving up control. We collaborate with like-minded hospital systems and care centers to create a seamless, integrated experience that improves outcomes and lowers costs. You're not just a participant - you're our partner.

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.
• 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).
• 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) or equivalent certification.
• Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies.
• High school diploma or GED required; associate’s or bachelor’s degree preferred.
• 2+ years of medical coding, billing, or risk adjustment experience.
• 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.

This position requires 50-75% local travel and is eligible for standard IRS mileage reimbursement.