Conduct comprehensive MS-DRG and APR-DRG coding audits to validate assignments and identify overpayments.
Apply advanced ICD-10-CM/PCS coding guidelines and AHA Coding Clinic references to produce defensible audit findings.
Prepare clear audit reports and collaborate with stakeholders to maintain high quality and regulatory compliance.
We're a healthcare auditing company specializing in DRG and inpatient coding reviews, ensuring accuracy and reimbursement compliance for leading healthcare clients. We foster a collaborative, inclusive, and supportive remote culture with mentorship programs and ongoing professional development.
Conduct comprehensive inpatient coding audits to identify discrepancies and compliance issues.
Provide clear audit findings and actionable recommendations to coding professionals.
Manage multiple client assignments while meeting productivity targets and quality standards.
Our partner provides inpatient coding audit services to healthcare organizations, ensuring coding accuracy and compliance. They offer a collaborative, remote culture with supportive management and professional development opportunities.
Manages systems and operations for inpatient coding, ensuring accurate and compliant ICD-10 code assignments and DRG determinations.
Serves as a liaison and coordinator for special projects, interacting with clinical and financial teams to maintain regulatory and revenue integrity.
Trains and monitors coding specialists, setting daily priorities to assure timely billing and compliance.
The Ohio State University is a top-20 public university and one of America's leading academic health centers, focused on education, research and health care. It offers a collaborative culture with a strong sense of community, Buckeye spirit, and abundant resources for employees.
Review inpatient medical records to validate DRG coding accuracy.
Apply clinical judgment to identify discrepancies, coding errors, and overpayments.
Document evidence-based audit findings and meet quality standards.
The company specializes in healthcare claims auditing and analytics, improving accuracy and consistency in payments. It is a collaborative, fully remote environment that values precision, teamwork, and continuous improvement.
Assigns ICD-9 and/or ICD-10 codes to inpatient encounters with the highest accuracy following official coding guidelines.
Works closely with physicians, clinical documentation specialists, quality, and patient finance teams to ensure accurate DRG assignment and data extraction.
Plays a key role in billing, research, regulatory compliance, and reporting to support patient acuity and quality outcomes.
Emory Healthcare is a comprehensive health system providing patient care, research, and education across multiple hospitals and clinics. They foster a supportive culture with mentorship, leadership programs, and a focus on professional growth, serving a large and diverse workforce.
Analyze and interpret complex records to accurately bill for Trauma 1 facility Inpatient services.
Assign and sequence correct diagnostic and procedure codes in compliance with third-party payor requirements.
Obtain clarification on conflicting, ambiguous, or non-specific documentation as needed.
Sutherland engineers digital outcomes for global enterprises through AI, automation, and cloud engineering. With 363 unique inventions and 250 AI-based patents, we drive digital transformation at scale for iconic brands.
Conduct thorough patient chart reviews to identify and validate reportable diagnoses.
Assign accurate ICD-10-CM diagnosis codes and apply MEAT criteria to support risk adjustment.
Collaborate with providers and quality teams to improve HCC documentation accuracy.
Bluestone provides coordinated, proactive care for patients with complex chronic conditions and disabilities. Its culture of Dedication, Excellence, Collaboration, and Caring has earned Top Workplace honors for 14 years.
Review, analyze, and code documentation for hospital inpatient medical records.
Select and sequence appropriate ICD-9-CM and ICD-10-CM diagnosis and procedure codes.
Take primary responsibility for inpatient coding accuracy and compliance.
Piedmont Healthcare is a healthcare organization providing medical services across multiple facilities. It fosters a supportive culture with a focus on employee wellness, recognition, and comprehensive benefits.
Oversee inpatient coding quality operations and ensure coding compliance with ICD-10 and CMS regulations.
Supervise remote coding audit staff and drive continuous improvement in accuracy and productivity.
Collaborate with clients, HIM, and CDI teams to optimize documentation and reimbursement outcomes.
The company provides inpatient coding quality management and revenue cycle services to multiple healthcare clients. It operates with remote teams and emphasizes compliance and performance improvement.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Partner with Clinical, Claims, and SIU teams to review claims for billing and coding issues.
Leverage internal AI tools and predictive models to identify anomalous billing patterns and support prepayment audits.
Collaborate with Data Science and Engineering to validate AI-flagged claims and refine machine learning models.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep members healthier. It is a fast-growing, remote-first startup with a mission-driven, collaborative culture focused on improving healthcare.
Perform inpatient coding quality audits and reviews to ensure accuracy and compliance with coding guidelines and regulatory requirements.
Analyze audit results to identify coding trends and provide feedback, education, and coaching to internal coders and clients.
Participate in senior-level projects such as ICD-10 assessment and development of audit tools and training materials.
UASI provides healthcare auditing and consulting services, specializing in inpatient coding quality and education. With over 40 years of experience, the company has been recognized as a Top Workplace and offers a collaborative, remote work culture.
Evaluate outpatient referrals and inpatient admissions for medical appropriateness.
Perform peer-to-peer discussions with providers and support utilization management processes.
Mentor UM nurses and contribute to clinical guideline development.
Clover Health is reinventing health insurance by combining data with human empathy to keep members healthier. It is a mission-driven company focused on providing high-quality, affordable healthcare for America's seniors.
Conduct clinical reviews of medical records during fraud investigations and program integrity initiatives.
Apply Medicare and Medicaid guidelines to determine appropriateness of payment coverage.
Compile investigative summary reports and provide training on medical terminology and policy interpretation.
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk. They are an equal opportunity employer committed to diversity and inclusion, maintaining a drug-free workplace.
Assigns ICD-10-CM, CPT/HCPCS codes and modifiers for outpatient encounters such as clinic, diagnostics, and EMS.
Ensures compliance with official coding guidelines, payer policies, and facility requirements while meeting quality benchmarks.
Collaborates with CDI, billing, and revenue integrity teams to improve documentation and optimize reimbursement.
Capital Health is a dynamic healthcare network that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. With more than 600 physicians and providers, the organization is accredited by DNV and emphasizes attracting top talent through competitive compensation and a collaborative culture.
Reviews, analyzes, and assigns codes based on appropriate coding guidelines for outpatient medical records.
Primary coding includes Diagnostic/Clinical, Emergency Room, Recurring, and Specimen patient types.
Ensures accurate coding using ICD-10-CM and CPT-4 HCPCS codes.
Piedmont Healthcare is a healthcare system that provides comprehensive medical services. It is a large organization with a focus on employee wellness and recognition, fostering a supportive and collaborative culture.
Ensures accuracy, completeness, and compliance of medical coding and clinical documentation.
Reviews patient records and coded data to identify discrepancies and support proper reimbursement.
Conducts chart reviews and audits, provides coding education, and prepares audit reports.
Emory Healthcare is a comprehensive healthcare system based in Atlanta, GA, providing a range of medical services. The organization fosters a supportive culture with mentorship, leadership programs, and comprehensive benefits.
Audit inpatient medical records to validate ICD-10-CM/PCS coding, DRG assignments, and compliance.
Identify documentation gaps and develop compliant physician queries while collaborating with physicians.
Maintain productivity of at least three chart reviews per hour and complete accurate audit workpapers.
The hiring company provides clinical documentation improvement consulting services to healthcare organizations, focusing on accurate coding, compliance, and reimbursement. It fosters a collaborative, people-first environment and has been recognized as a Great Place to Work for three consecutive years.
Assign and verify CPT, ICD-10 CM coding and modifiers based on documentation, ensuring compliance with official coding guidelines.
Resolve claim edits and denials, monitor charge capture volumes, and work with providers and clinic staff to ensure accurate charge capture.
Act as a subject matter expert in one or more specialties, identify trends and educational opportunities, and may train other coders.
Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children, providing a wide range of care from routine visits to life-saving treatments. The organization fosters a diverse and inclusive culture and seeks individuals committed to its vision of the healthiest kids in the country.
Oversee inpatient coding operations, including personnel management and workflow optimization.
Monitor performance metrics like DNB reports and timely filing to support financial health.
Ensure regulatory compliance and collaborate with HIM, IT, and CDI teams on complex coding issues.
CommonSpirit Health operates more than 700 care sites across the U.S., making care accessible to nearly one in four residents. The organization is driven by compassion and a commitment to building healthy communities and advocating for the vulnerable.