Conduct coding audits to ensure accuracy and compliance with coding guidelines.
Identify compliance risks and recommend corrective action plans.
Provide education and training to physicians and staff on coding best practices.
Theoria Medical is at the forefront of healthcare innovation and quality, offering a blend of medical excellence and technological advancements, primarily serving the post-acute sector. Their network includes multispecialty physician services across skilled nursing facilities nationwide, fostering a mission-driven culture that values expertise and innovation.
Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Accountable to meet and maintain established department production and quality standards.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Coordinate medical record retrieval, ensuring complete and timely submission of patient documentation for provider review
Prepare and process referrals to specialists and manage prior authorization requests in coordination with insurance payors
Virtually greet and room patients prior to telehealth appointments, confirming patient information and visit readiness
Synapticure is a patient and caregiver-founded company that provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. They are dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and ALS.
Assist in preparation and review of policies, procedures, and agreements.
Research diverse topics; review internal operations and practices to ensure compliance.
Collaborate with teams across marketing, cybersecurity, IT, product, finance, and business functions.
Topstep is an engaging company that exists in both remote and hybrid environments. They foster a culture of collaboration by keeping cameras on during meetings and maintaining a robust Slack environment for communication.
Serve as embedded regulatory thought partner to Clinical and Operations teams, providing real-time guidance.
Partner with Clinical and Compliance team on policy development, audit response, and remediation strategies.
Translate complex healthcare regulations into practical guidance and tools.
Headway is building a new mental healthcare system everyone can access by solving the biggest barrier to care: insurance. They have over 75,000 providers across all 50 states run their practice on their software, serving over 1 million patients.
Evaluate and analyze health insurance applications to determine the risk they pose, helping to set premium rates that are both fair and competitive.
Interpret and analyze underlying claims experience to inform underwriting decisions and policy adjustments.
Work closely with sales teams to develop competitive insurance products and strategies, ensuring alignment with company goals and client needs.
Evry Health's mission to bring humanity to health insurance with high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach, striving to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents; for more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.
Manage day-to-day credentialing and re-credentialing workflows for Tia’s provider network.
Support medical licensing workflows for MDs, DOs, NPs, PAs, and RNs across multiple states, including tracking requirements, deadlines and renewals.
Track onboarding progress and help ensure providers are licensed, credentialed, enrolled, and compliant before go-live.
Tia is building a new model for women’s healthcare, one that treats women as whole people. They are a Series D, venture-backed company trusted by more than 120,000 women across four markets, building a culture of excellence in people, process, and product.
Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Answer calls and resolve questions, routing to appropriate departments.
Complete documentation in EMR and marketing systems, including initial prescreening.
Schedule new and returning patients and complete follow-up duties.
Pyramid Healthcare provides addiction treatment, mental health recovery, and eating disorder treatment. They focus on client-centered care and offer supportive environments that help patients overcome life’s challenges.
Primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements.
Assist with data collection, analysis and reporting for process improvement efforts.
Plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.
Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health has a supportive, growth-oriented environment and diverse, inclusive teams.
Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.
Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.
Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.
Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine. Guidehealth is a growing and innovative organization and employees are expected to adapt to evolving business needs.
Perform accurate code assignments for ED records (facility and profee) while working remotely.
Be flexible, detail-oriented and have the ability to work independently.
Meet client productivity targets while maintaining coding quality of 95% or greater.
UASI is a company that values its employees! They have been awarded the Top Workplace award by the Cincinnati Enquirer in 2022 and 2023. Their 40 years in business contributes to the long tenure of their team.
Manage end-to-end travel arrangements for Healthcare Professionals in strict compliance with regulations and internal frameworks.
Negotiate competitive fares with airlines, hotels, and ground suppliers to secure favorable rates.
Maintain strong client focus and deliver exceptional service while handling short-lead requests within SLA.
R&M provides travel management services specializing in complex, compliance-driven travel for healthcare professionals and corporate clients. The company values team collaboration and has a focus on delivering outstanding client support across global markets.
Assist residents, vendors, and property teams via phone, email, and online channels, providing timely and professional solutions.
Coordinate and track service requests from start to finish, scheduling appointments and ensuring timely follow-up with internal departments and suppliers.
Maintain accurate records, perform data entry, and support administrative tasks while complying with company policies and data privacy standards.
Thrive Communities LLC aims to be the most trusted property management partner by delivering exceptional results and enhancing quality of life for residents. The company values responsibility and cooperation, building communities where residents feel at home and coworkers are inspired to develop their skills, with a growing team.
Works with field staff and Manager, Clinical Services (MCS) to appropriately schedule clinicians for cases in assigned areas of responsibility.
Communicates appropriately regarding changes in schedule or service delivery.
Demonstrates the ability to be efficient and productive by organizing job duties and responsibilities.
CommonSpirit Health at Home is a full-service health care organization that believes the best place for someone to get better is in their own home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and the health of the communities we serve.
Own clinical quality strategy for a rapidly scaling network spanning 20+ states, 400+ clinicians, and multiple care models.
Build clinical compliance policy infrastructure that anticipates growth rather than reacts to it.
Lead and develop a team that grows with the organization.
Cartwheel builds a new kind of mental health program for kids that puts schools at the center, supporting school staff. They are an early-stage company backed by top investors and looking for mission-driven teammates.
Review and audit clinical documentation for accuracy, timeliness, and regulatory compliance.
Ensure documentation meets Medicare Conditions of Participation, state regulations, and accreditation standards.
Lead and support Quality Assurance and Performance Improvement initiatives, tracking key clinical and operational indicators.
They are fixing US healthcare by building an AI-native physical care platform, starting with home health. The company is automating administrative work with AI to create a fundamentally different cost structure than incumbents, enabling them to serve more patients.
Accountable for the development and maintenance of clinical and reimbursement policies, ensuring alignment with CMS regulations.
Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and national coding guidelines.
Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies.
Clover Health focuses on improving the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They aim to empower their members by helping them navigate the complexities of healthcare and live healthier lives and are passionate about making healthcare easier, more affordable, and more accessible for everyone.
Drafts and maintains medical information content for the Medical Information Call Center (MIC).
Provides guidance to Medical Information Managers on drafting standard medical responses and FAQs.
Reviews MIC case records to ensure accuracy of response and compliance with regulations.
Vertex is a global biotechnology company that invests in scientific innovation to create transformative medicines for serious diseases. The company is consistently recognized as one of the industry's top places to work, with a diverse and inclusive culture.
Deliver an outstanding customer experience by supporting inquiries across phone, email, text, and chat.
Manage high-complexity insurance workflows and inbound support requests to collect documentation.
Partner with clinical, scheduling, and operations teams to ensure accurate treatment plan alignment and continuity of care.
Expressable is a virtual speech therapy practice that aims to transform care delivery and expand access to high-quality services. Since 2019, they serve thousands of clients with a focus on parent-focused intervention and an e-learning platform with home-based learning modules.