Perform complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules.
Collaborate with operations consultants, RCM AR staff, and management to address Care Center payment performance audits and maximize cash flow.
Identify, monitor, and manage denial management trends, and work closely with Revenue Cycle Teams and payer representatives.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, focusing on reducing healthcare costs and improving outcomes.
Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools.
Partner with data science teams to validate AI outputs and improve model performance.
Serve as a coding subject matter expert to support audit concept development and optimization.
Cotiviti is a healthcare analytics company specializing in payment integrity and data-driven solutions. The company fosters a collaborative culture and emphasizes innovation in healthcare audit and analytics.
Analyze claim selection processes and AI-enabled methodologies to optimize payment integrity outcomes.
Collaborate with data scientists and analytics teams to validate coding and reimbursement accuracy.
Serve as subject matter expert in healthcare billing, coding, and regulatory compliance.
Cotiviti is a healthcare payment integrity company that leverages data and AI to improve claim accuracy and compliance. They are a large organization with a collaborative culture focused on innovation and operational excellence.
Review healthcare claims and determine appropriate payment methodologies based on contractual terms and client requirements.
Analyze claim information and system data to ensure accurate repricing while meeting productivity and quality metrics.
Collaborate with internal audit and operational teams to support compliance, quality assurance, and process improvement initiatives.
The company provides healthcare claims review and repricing services. It operates remotely with a focus on compliance, accuracy, and continuous improvement.
Conduct quality assurance and audit planning for the WTC Health Program, reviewing claims and analyzing data to identify trends and issues.
Research federal payer coverage policies and develop program policies and procedures, maintaining the health plan codebook.
Collaborate with clinicians and subject matter experts to support medical management and claims review, ensuring accurate application of medical coding standards.
Advanced Technologies & Laboratories International (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit for the World Trade Center Health Program. The company offers a competitive total compensation package including paid leave, medical, dental, vision, and a 401(k) retirement plan.
Develop and maintain risk-adjusted provider group performance models using CMS-HCC methodology.
Analyze large healthcare datasets, including Medicare claims (CCLF and BCDA), to monitor financial performance.
Create executive dashboards and present findings to leadership and clinical stakeholders.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider serving patients across multiple US states. They provide in-home care for chronic conditions and limited mobility, with a culture driven by the motto 'To Care is an Honor.'
Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient and outpatient claims.
Conduct in-depth claims analysis using coding principles and electronic health information systems to ensure assigned codes are supported by documentation.
Meet quality and production standards and ensure compliance with quality management systems and ISO requirements.
Empower AI provides AI for government, helping federal agencies transform their workforce. With three decades of experience in Health, Defense, and Civilian missions, it is headquartered in Reston, VA and recognized as a 2024 Military Friendly Employer.
Review and process healthcare claims in accordance with payer requirements and established procedures
Verify claim information for accuracy, completeness, and consistency before submission
Work with billing and coding teams to investigate and resolve claim-related issues
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. They foster a remote work environment and value accuracy, teamwork, and continuous improvement.
Act as a subject matter expert on medical payment policy, analyzing client data and presenting new policy opportunities to health plans.
Collaborate with Client Medical Directors and internal teams to develop and advocate for adoption of medical policies that maximize value.
Prepare presentations, coordinate reviews, and inspire trust as a trusted advisor for the Health Plan's medical payment strategy.
Cotiviti is a healthcare analytics company that partners with health plans to optimize payment accuracy and medical policy through data-driven solutions. The company employs a global workforce and fosters a collaborative, client-focused culture.
Evaluate dispute eligibility and documentation to ensure cases meet federal IDR or state-specific requirements before submission.
Research and interpret state regulatory requirements, translating them into clear workflows for the team.
Monitor arbitration timelines, track correspondence, and maintain accurate case records to support operational improvements.
Pivotal Health is a technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. We are a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers.
Submit provider and organizational contract requests to commercial, Medicare, Medicaid, and managed care payers.
Monitor contract application status and maintain detailed tracking of all submissions and negotiations.
Coordinate with internal teams to facilitate successful implementation of newly executed agreements.
Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services. Since 2019, we have served thousands of clients and maintain a fully remote culture focused on collaboration and personal connection.
Develop and maintain audit concepts by researching regulatory, coding, or payer policy changes and updating rule documents and code lists.
Perform QA reviews to ensure audit concepts comply with coding standards, payment methodologies, and payer policies prior to deployment.
Collaborate with cross-functional teams including operations, clinical, and client services to support policy execution and drive concept quality.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering value and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, we are a digital-first, AI-powered platform that reimagines what's possible in healthcare.
Serve as primary financial contact for assigned projects, reviewing contracts and ensuring accurate invoicing of study visits and billable activities.
Reconcile clinical trial data between systems, identify revenue discrepancies, and prepare monthly revenue files for ERP upload.
Support collections, study close-out audits, and use data analysis to improve financial processes and maintain compliance.
Jobgether is an AI-powered recruitment platform that matches candidates to job openings. It uses technology to process applications and shares shortlisted candidates with hiring companies, supporting a mission-driven healthcare environment.
Update and maintain provider file databases with submitted documentation.
Research and resolve provider contract file edits and claims issues.
Analyze reports for data corrections and ensure quality control of provider files.
Blue Cross Blue Shield of Arizona is a health insurance company dedicated to inspiring health and making it easy. With over 80 years of service and more than one million members, they offer a hybrid work environment called Workability that emphasizes flexibility.
Manage day-to-day payer implementation projects with timelines and open items across teams.
Prepare polished payer-facing materials including project plans and decision logs.
Coordinate with Clinical, Operations, Finance, and Legal to resolve issues and support post-launch account management.
Chamber Cardio rebuilds the cardiology system around outcomes by equipping independent cardiologists with technology and operational tools. The company partners with physicians to lead population health efforts, combining AI tools with human-centered care to transform heart health at scale.
Lead the strategy to secure national payor agreements, moving from state-by-state enrollment to national in-network contracts with major commercial payors.
Manage a Credentialing Specialist, setting SLAs and KPIs for credentialing turnaround time, while overseeing payor enrollment and claim denial resolution.
Partner with Clinical Ops and Revenue Cycle to align provider onboarding with credentialing lead times and national agreement rollouts.
Happy Health is revolutionizing sleep medicine delivery through a comprehensive telehealth platform that eliminates traditional barriers to sleep care. The company is a fast-moving, low-ego team that values ownership and problem-solving over process, operating remotely with a physical office in Austin, TX.
Coder III demonstrates proficiency in coding high acuity inpatient accounts and/or technical outpatient accounts.
Utilizes ICD-10-CM, PCS, HCPCS, CPT, and other coding references for accurate coding.
Supports Revenue Cycle goals for timely billing.
Cooper University Health Care is committed to providing extraordinary health care. We offer competitive rates, comprehensive benefits, and opportunities for career growth.
Review and process medical, supplemental, or dental claims according to benefits, eligibility, and guidelines.
Validate accuracy of medical codes, assess eligibility, and evaluate authorizations in claim submissions.
Meet or exceed quality and productivity goals while working independently in a virtual environment.
The Cigna Group is a health services company dedicated to improving the health and vitality of those they serve. It is a large organization with a focus on innovation and employee well-being.
Build and iterate on pro formas to support live sales cycles, partnership deals, and pricing decisions.
Evaluate deal economics, assumptions, and risk using business judgment alongside formulas.
Own RFP responses end to end, coordinating input from technical, legal, and business stakeholders to deliver clean, accurate submissions on deadline.
Pivotal Health is a technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. It is a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers.
Own the data work behind accurate client billing, reconciling across systems and building durable checks.
Partner with the Client Group to support timely billing and answer pressing data questions.
Develop reporting and dashboards that surface billing trends, risks, and anomalies.
Virta Health is transforming type 2 diabetes and weight-loss care through technology, personalized nutrition, and virtual care. They have raised over $350 million from top-tier investors and partner with health plans, employers, and government organizations.