Healthcare Practice Transformation Specialist

Palm Beach Accountable Care Organization; Plainsboro Township (NJ); On-site; USD 70,000 - 105,000; Full time

Job summary

Palm Beach Accountable Care Organization seeks a Healthcare Practice Transformation Specialist to bridge physician practices with our organization. You will provide EHR training, review clinical docs for risk adjustment coding, and support billing with a focus on Medicare Advantage and quality outcomes.

The ideal candidate is a CPC with strong analytics and training skills, ready to travel locally 50-75% and work across partner practices to optimize workflows and documentation.

Qualifications

• Certified Professional Coder (CPC) or equivalent certification.
• Experience with Medicare Advantage, risk adjustment, or insurance companies.
• High school diploma or GED; associate/bachelor preferred.
• 2+ years of medical coding, billing, or risk adjustment experience.
• Proficient in EHR systems (Athena, eClinicalWorks) and MS Office (Excel).
• Strong knowledge of ICD-10, CPT, HCPCS and regulatory compliance.
• Excellent communication and training skills for providers and staff.

Responsibilities

• Support physician networks to ensure EHR integration and troubleshooting.
• Consult with practices to analyze workflows and tailor training plans.
• Train physicians and staff on EHR best practices and regulatory compliance.
• Review clinical documentation for accurate ICD-10, CPT, HCPCS coding.
• Conduct coding audits and educate providers on compliant documentation.
• Monitor payer guidelines and coding updates, especially MA and ACOs.
• Assist with billing, claims submission, payment posting, and collections.
• Perform financial analysis and reporting in Excel (pivot tables).
• Analyze denial reports and recommend corrective actions.
• Support quality improvement through accurate coding of chronic conditions.
• Answer patient billing questions professionally.
• Maintain HIPAA compliance and company policies.

Skills

Certified Professional Coder (CPC)

Medicare Advantage experience

Healthcare analytics

Communication & training skills

Education

High school diploma or GED

Associate’s or bachelor’s degree preferred

Tools

Athena

eClinicalWorks

MS Office / Excel

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.