Conduct clinical and billing reviews of claims, itemized bills, and UB-04 forms to ensure accuracy.
Perform utilization reviews to assess medical necessity and validate charges against policies.
Mentor reviewers, meet productivity targets, and maintain active RN licensure with CEUs.
Our partner is a healthcare services company that conducts medical claims and utilization reviews to ensure accurate billing and appropriate care. They offer a collaborative, quality-focused remote environment with opportunities for professional development.
Audit skilled nursing facility (SNF) medical claims for medically appropriate services using applicable guidelines and policies.
Document findings, generate audit letters, and support audit findings during the appeals process.
Work collaboratively with the audit team, clients, and contractors to improve medical policies and audit workflows.
Machinify is a healthcare intelligence company with expertise across the payment continuum, delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company combines an AI-powered platform with best-in-class expertise to drive down healthcare costs.
Audit inpatient and outpatient records for coding accuracy, documentation support, and reimbursement impact.
Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG, modifier, and bundling assignments across facilities.
Present findings and provide facility-specific coding education to leadership and stakeholders.
A large regional health network operates multiple medical facilities across the United States, focusing on accurate coding and compliance. The organization maintains a structured, regulated environment with an emphasis on quality improvement, education, and confidentiality.
Conduct independent coding audits of inpatient, outpatient, and professional fee services across multiple specialties.
Analyze sampled medical records to identify and substantiate coding, documentation, and compliance errors.
Provide targeted education and train-the-trainer sessions to strengthen coding practices.
This company provides medical coding auditing and validation services for Veterans Affairs medical centers, supporting healthcare data quality and compliance. It operates in a mission-driven environment focused on improving coding accuracy for veteran-serving facilities.
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.
Conduct comprehensive reviews of home health pre-claim review packages for Medicare compliance.
Document review outcomes with clinical rationale and meet a 7-business-day turnaround.
Maintain 98% accuracy and complete required training and quality assurance sessions.
Broadway Ventures is a consulting firm providing program management, technology, and innovative solutions to government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, it emphasizes integrity, collaboration, and excellence in its culture.
Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance.
Review up to 25 diagnoses and procedures per record, classify errors with references.
Deliver facility audit reports and lead training sessions for coding staff and clinicians.
Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach.
Conduct clinical reviews of inpatient admissions and continued stays using approved medical necessity criteria.
Collaborate with physicians, care managers, and payer teams to resolve utilization concerns and prevent denials.
Support quality improvement initiatives, maintain accurate documentation, and communicate review outcomes effectively.
This role is with a partner company focused on healthcare utilization management, helping hospitals improve patient outcomes and ensure appropriate resource use. The team operates as a distributed remote group supporting care coordination, revenue integrity, and clinical compliance.
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.
Independently audit professional-fee coding for accuracy, compliance, and reimbursement impact.
Evaluate ICD-10-CM, CPT, HCPCS Level II, E/M services, modifiers, and professional components.
Prepare reports, deliver coding education, and maintain 95% audit accuracy.
A large regional healthcare network providing medical services across multiple facilities. The culture emphasizes independent auditing, high accuracy, and collaborative compliance education.
Perform concurrent medical record reviews on nursing units to clarify patient documentation.
Prompt physicians to resolve missing, unclear, or conflicting documentation for appropriate reimbursement.
Provide education to patient care providers on clinical documentation standards and coding requirements.
Virginia Mason Franciscan Health provides a full spectrum of health care services across the Puget Sound region, with a legacy of compassionate care and innovation. With 10 hospitals and nearly 300 care sites, the organization is dedicated to healing the whole person through rigorous research, education, and collaboration.
Review inpatient and outpatient records and assign accurate ICD-10, CPT, and HCPCS codes.
Maintain a minimum coding accuracy of 95% while meeting turnaround and quality standards.
Work fully remotely within the US supporting multiple medical facilities.
This position is listed on behalf of a partner company within a large healthcare network. They focus on health information management and clinical coding accuracy, offering a fully remote environment.
Review complex inpatient medical records and assign ICD-10-CM, ICD-10-PCS, and DRG codes accurately.
Ensure compliant documentation and billing by applying federal and VHA coding guidelines.
Maintain 95% coding accuracy and meet facility-specific turnaround requirements while working remotely.
This role is with a partner company that supports inpatient coding operations for Veterans Affairs medical centers. The environment is structured and mission-driven, with a focus on accuracy, compliance, and federal healthcare standards.
Analyze and summarize medical records, highlighting relevant clinical findings for attorneys.
Prepare medical chronologies and long-term care assessments to support case evaluations.
Provide objective, evidence-based medical insights and coordinate with expert witnesses.
The partner company provides specialized legal nurse consulting services to attorneys, analyzing medical records and supporting injury-related cases. This role offers flexible, part-time contract work in a fully remote environment.
Conduct routine and targeted coding audits for internal and outsourced vendors across ASC, hospital outpatient, and professional fee services.
Review ICD-10, CPT, HCPCS, and payer policies to ensure coding accuracy, compliance, and documentation support.
Prepare audit reports, identify trends, provide coder education, and support performance improvement initiatives.
Surgery Partners is a healthcare services company operating ambulatory surgery centers and related facilities across the United States. With more than 58 facilities, the company prioritizes compliance, quality, and a diverse, inclusive workplace.
Review, investigate, and appeal denied hospital insurance claims using clinical documentation and payer policies.
Develop evidence-based appeal letters addressing medical necessity, level-of-care, and charge discrepancies.
Collaborate with nursing, revenue integrity, and financial teams to resolve denials and prevent future rejections.
This partner company is a healthcare system that provides hospital services and focuses on revenue integrity. It supports fully remote work and values clinical expertise, collaboration, and financial sustainability.
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.
Audit surgical and procedural coding for accuracy, documentation support, and compliance with ICD-10-CM, CPT, and HCPCS guidelines.
Document findings with authoritative guidance, assess financial impact, and recommend corrective actions.
Deliver facility-specific coding education and collaborate with health information management leadership and facility stakeholders.
A healthcare organization is seeking a Surgery Coding Auditor to ensure accurate surgical coding and compliance. The company operates across multiple healthcare facilities in the US and emphasizes quality assurance, education, and process improvement.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established coverage guidelines.
Educate teams on medical review processes and support quality control activities.
Broadway Ventures is a veteran-owned small business delivering mission-critical support to federal health and defense customers. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, it is built on integrity, collaboration, and excellence.
Performs pre-admission, admission, and continued stay reviews using approved medical necessity criteria.
Coordinates patient care and communicates with physicians, patients, caregivers, and third-party payers.
Manages patient progression through the healthcare system and proactively works with payers to secure certification and minimize denials.
Ochsner Health is a leading not-for-profit healthcare provider in the Gulf South, with 46 hospitals and 370+ care centers. It employs more than 38,000 team members and has been recognized as a top workplace and the No. 1 hospital in Louisiana.