Demonstrates knowledge of basic audit skills and adheres to Internal Audit Standards and UPH Internal Audit policies and methodologies.
UnityPoint Health is committed to their team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row. They champion a culture of belonging where everyone feels valued and respected, and believe in equipping you with support and development opportunities to deliver an exceptional employment experience.
Conduct audits comparing medical record documentation to reported codes.
Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.
Provide feedback, education, training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision and coding principles.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. Their platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Perform chart scrubbing and clinical documentation audits to ensure completeness and accuracy.
Review records to validate ICD-10 diagnosis coding and supporting clinical documentation.
Ensure compliance with PDPM (Patient-Driven Payment Model) and CMS guidelines.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging their extensive global network, they connect clients with highly qualified professionals, offering tailored services to meet clients' unique business needs.
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.
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.
Creates and delivers education to the Coding Team, Clinical Documentation Nurses, Physicians, and other licensed providers to improve documentation quality.
Collaborates with CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
Monthly monitoring of the clinical dashboard demonstrating improvement in statistical targets.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system.
Conduct quality audits of inpatient clinical determinations to ensure alignment with clinical guidelines and quality standards
Analyze QA findings and translate insights into actionable recommendations for operational leaders and cross-functional partners
Provide coaching and feedback to improve clinical decision accuracy, guideline adherence, and overall team performance
Cohere Health delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and are backed by leading investors such as Deerfield Management. The coherenauts who succeed there are empathetic teammates who are candid, kind, caring, and embody their core values and principles. Cohere is deeply invested in ensuring that they have a supportive, growth-oriented environment that works for everyone.
Design, execute, and ensure operational excellence of risk adjustment coding and clinical documentation programs.
Create scalable, physician-centric educational programs for accurate and complete diagnosis documentation.
Lead a multidisciplinary team of coders, auditors, and analysts to ensure operational excellence and talent development.
Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. They're the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
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.
Participate in provider case reviews to identify trends and deficits.
Coach providers and participate in client meetings to support expectations.
Contribute to workflow design, QA improvements, and risk management.
Amwell transforms healthcare with technology and people. They aim to provide convenient, affordable, and effective care, serving large healthcare organizations in the U.S. and worldwide.
Review all assigned OASIS assessments for accuracy, completeness, and consistency.
Validate diagnosis coding and sequencing per CMS guidelines.
Identify and correct errors impacting reimbursement, quality measures, or compliance.
They are responsible for coding, reviewing, validating, and correcting OASIS assessments to ensure clinical accuracy, regulatory compliance, and optimal reimbursement. This is an adaptive, remote-friendly role designed to scale with agency census and workflow needs.
Perform coding audits and reviews on a variety of professional fee record types.
Perform necessary research in order to provide the client with supportive regulatory and coding guideline documentation.
Assist in the design and presentation of educational seminars to clients and staff
UASI is an award-winning company with over 40 years of experience, offering consulting services. We have enduring partnerships with our valued clients, stability, and long-term success of our dedicated team.
Provide high-quality supervision, mentorship, and training to residents and pre-licensed clinicians.
Promote clinical excellence, ensure compliance with state licensure and CARF standards.
Maintain a small caseload to model best practices and stay grounded in direct care.
Backpack Health is building the next generation of exceptional behavioral health clinicians. It is a mission-driven team of clinicians and operators in an innovative, forward-thinking environment with a strong clinical community and mentorship culture.
Evaluate hospital admissions, continued stays, and post-acute services for Medicare Advantage members.
Guide timely care determinations using CMS regulations and evidence-based practices while collaborating with care management teams and external providers.
Conduct timely medical necessity determinations for inpatient admissions and post-acute settings.
HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance.
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.
Coordinate and support the hospital’s Utilization Review and Case Management program.
Review patient charts and clinical documentation to verify medical necessity.
Monitor patient progress and coordinate care management strategies.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. With hospitals in Indiana, Michigan, Texas, and Arizona, they’re expanding access to their unique model of care across the United States.
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.
Own the execution of clinician chart audits and watchlist tracking.
Investigate clinical incidents, chart audits, and collaborate on root cause documentation.
Track quality, safety, and clinician performance metrics using manual and automated tools.
Wheel is evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. They offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.