Analyzes and Audits Claims; Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities.
Effectively Utilizes Audit Tools; Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
Meets or Exceeds Standards/Guidelines for Productivity and Accuracy/Quality.
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Machinify is a healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They deploy a configurable, AI-powered platform and best-in-class expertise, serving over 85 health plans representing more than 270 million lives.
Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition.
Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG. Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed.
Works with Coders and CDSs to draft and initiate physician queries.
Emory Healthcare is a healthcare system in Atlanta, GA. We fuel professional journeys with benefits, resources, mentorship, and leadership programs, fostering a supportive environment.
Perform audits to assess the quality of documentation, accuracy of charge code assignment and review financial billing statements.
Answer any physician and/or clinic questions and concerns regarding current ICD-10 and CPT guidelines.
Provide coding training and updates for coding staff, physicians and clinics as assigned.
Shirley Ryan AbilityLab is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions. They have an innovative, multifaceted culture that embraces collaboration, excellence, discovery, and compassion.
Lead prospective claim review audits related to clinical DRG coding compliance and readmissions programs.
Act as Subject Matter Expert to counsel other team members across Clover on clinical coding guidelines.
Collaborate with teams across Clover to ensure provider understanding of Payment Integrity recommendations.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most; they are passionate and mission-driven individuals.
Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types
Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans
Perform necessary research to provide to the client to support findings.
UASI is recognized as a Top Workplace. With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we’ve built and the long-term success of our dedicated team.
Perform comprehensive medical record and claims review to make payment determinations for Medicare PART A.
Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides federal agency leaders with tools to elevate their workforce's potential through meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions.
Assigns ICD-10-CM/PCS codes and assigns DRGs for inpatient medical records accounts; assigns ICD-10-CM/PCS codes and CPT codes for outpatient medical record accounts
Abstracts key data elements required for billing
Interacts with providers for clarification of documentation/education
UChicago Medicine has been at the forefront of medicine since 1899 and provides superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, they need employees with passion, talent and commitment… with patients and with each other.
Ensuring the accuracy, integrity, and quality of coding practices within the HIM department.
Conducting thorough reviews of clinical documentation, coding, and billing processes to ensure compliance.
Educating and training coding staff on best practices and updates in coding guidelines.
Cooper University Health Care is committed to providing extraordinary health care. They focus on clinical innovations and access to facilities, equipment, technologies and research protocols, and offer competitive rates, compensation programs, benefits, and career growth.
Timely and accurate review of patient records at OASIS timepoints.
Communicate directly with internal & agency clinical staff as needed.
Maintain professional and technical knowledge.
BerryDunn is a professional services firm that has helped businesses, nonprofits, and government agencies throughout the US solve their greatest challenges since 1974. They are a client-centered, people-first firm recognized for its diverse and inclusive workplace culture, and its focus on learning, development, and well-being.
Review and analyze medical records to ensure coding accuracy in a timely fashion
Identify opportunities for improvement in coding models
Understand and apply coding guidelines to assign appropriate codes to diagnoses and procedures as supported by clinical documentation
SmarterDx builds clinical AI that is transforming how hospitals translate care into payment. Founded by physicians in 2020, their platform connects clinical context with revenue intelligence, helping health systems recover millions in missed revenue, improve quality scores, and appeal every denial.
Codes and abstracts hospital medical records for diagnostic and procedural coding.
Utilizes federal, state procedures/guidelines to assure accuracy of coding.
Collaborates with medical staff and clinical documentation improvement (CDI) staff to clarify documentation.
Virtua Health is dedicated to offering quality care through its extensive range of services and facilities. They have over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners committed to providing quality healthcare.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards with your expertise and training.
Review patient medical record information via population health tools to identify, assess, monitor and review network coding opportunities.
Dignity Health Management Services Organization (Dignity Health MSO) aims to build a system-wide integrated physician-centric, full-service management service organization structure. They provide management and business services, leveraging economies of scale and leading efforts in developing Medicaid population health care management pathways.
Review clinical information for appropriateness, congruency, and accuracy.
Review and communicate OASIS edit recommendations to each clinician.
Provide customer service/education and act as a resource to Medicare Certified Offices.
BAYADA Home Health Care delivers home health care with compassion, excellence, and reliability. As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates, with 50 years of experience.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.
Organizes and prioritizes assigned work to ensure completion within the assigned time frame.
Reviews charts and medical records, assigning ICD and CPT code combinations to each data element.
Audits for documentation opportunities and queries clinical staff to fill in any gaps.
Riverside Health System's mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team, offering care at all stages of life, in hundreds of locations.
Conducts audits of clinical documentation reviews to ensure compliance and regulatory requirements.
Develop and deliver training sessions based on audit findings to support CDI team competency.
Oversee the accuracy, specificity, and completeness of clinical documentation.
Adventist HealthCare is a faith-based, not-for-profit organization dedicated to improving the health and well-being of people and communities. They employ over 6,000 professionals and are one of the longest serving healthcare systems in the Washington, D.C., area.
Conducting inpatient coding reviews and SMART audits.
Providing feedback and education.
Detail-oriented and committed to quality, self-motivated, flexible and adaptable to change.
UASI works with top hospitals and HIM experts. They provide employees with the tools needed for professional growth and development and recognize that their employees are their greatest asset.
Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types.
Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures
Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
Northwestern Medicine is committed to a patient-first approach, setting them apart as a leader in healthcare. They pride themselves on providing competitive benefits, from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, aiming to care for their employees.
Abstract information from patient medical records to assign correct codes and charges to outpatient surgical records, and/or observation cases.
Assign correct CPT, ICD-10-CM; HCPCS or ICD-10-PCS and DRGs for facility and/or professional charges, which would involve complex procedure and diagnostic coding within highly specialized coding areas.
Monitor activity for compliance with federal and/or state laws regarding correct coding set forth by CMS and Oregon Medical Assistance program (OMAP).
OHSU is Oregon's only public academic health center. As Portland's largest employer, they offer learning and advancement opportunities in a system of hospitals and clinics across Oregon and Southwest Washington.