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.
Determines denials from remittance and explanation of benefits, trend root cause.
Crafts detailed appeal letters and contacting insurance payers for resolution.
Documents all actions taken for each claim within a claims recovery system.
TREND Health Partners is a tech-enabled payment integrity company with a mission to facilitate collaboration between payers and providers. They aim to improve access to healthcare by aligning common goals through a shared technology platform and seamless workflows. It is a dynamic, growing organization that promotes a collaborative and innovative work environment.
Perform comprehensive medical record and claims review to make payment determinations for Medicare PART A.
Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides federal agency leaders with tools to elevate their workforce's potential through meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions.
Submit bills compliant with all appropriate regulations and managed care contracts.
Collect money due by contacting third parties and providing explanations of charges.
Analyze accounts to determine coordination of benefits, refunds, and denials.
They are Oregon's only public academic health center, involved in patient care, research, and training healthcare professionals. As Portland's largest employer, they offer opportunities for learning and advancement in hospitals and clinics across Oregon and Southwest Washington.
Responsible for daily billing functions and claim edits.
Reviews insurance claims for accuracy and identifies non-payment issues.
Contacts parties for claim information and works first-level appeals.
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Their mission is to live God’s love by promoting and restoring health.
Provide first level review for all outpatient and ancillary pre-certification requests.
Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care.
Complete documentation for all reviews in Eldorado/Episodes and maintain confidentiality.
Personify Health created a personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. Their team is on a mission to empower people to lead healthier lives.
Resolve claims rejections and denials in work queues as assigned.
Resolve outstanding claims based on an accounts receivable report.
Submit appeals to payors for non-payment of claims as needed.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in multiple states. They offer a variety of programs designed to ensure patients receive the highest quality of care by a team they know and trust.
Serve as a subject matter expert for front-end revenue cycle functions.
Investigate and resolve complex billing issues that prevent claims from being successfully accepted by payers.
Conduct root cause analysis on recurring front-end issues and implement process improvements to reduce claim errors and rework
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions.
Responsible for complete, accurate, and timely processing of all designated claims.
Investigates denial sources, resolves and appeals denials, which may include contacting payer representatives.
Works with internal teams and care center staff to ensure optimal revenue cycle functionality.
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. Their platform consists of scalable operations and cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Perform comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment.
Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides AI tools for government to elevate workforce potential. They have three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.
Resolve aging AR through root cause analysis and follow up remediation actions.
Handle client and provider billing inquiry escalations
Investigate, appeal and resolve denied or underpaid claims
SonderMind is a mental health service provider aiming to provide personalized and effective mental healthcare. They combine technology and human connection to drive better outcomes through a comprehensive approach, offering therapy, medication management, meditation, and mindfulness exercises.
Monitor AR aging by region to identify overdue accounts and coordinate follow-ups.
Reconcile AR regularly to resolve discrepancies and denials.
Communicate with insurance providers to validate benefits and check authorization status.
Hazel Health and Little Otter have joined forces to deliver comprehensive services to the children and families. Hazel transforms schools into the most accessible front door to physical and mental healthcare, serving over four million K-12 students.
Performs concurrent inpatient utilization review using InterQual criteria to determine if requests meet medical necessity criteria.
Engages in clinical collaboration with physicians, hospitalists, and care teams to obtain clinical information.
Maintains knowledge of regulations, accreditation requirements, and payer-specific guidelines.
WNS Healthhelp, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. They bring together deep domain excellence with AI-powered platforms and analytics to help businesses innovate, scale, adapt and build resilience. With more than 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.
Acts as a resource for collection issues and ensures patient accounts are accurate.
Monitors patient A/R, sends statements, and posts payments according to standards.
Documents all activity on accounts and prepares data needed for court-related circumstances.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties. They are a team that delivers outstanding care in one of the most beautiful regions in the country.
Collaborates with departments to ensure timely and accurate charge capture, entry, documentation, and reconciliation.
Works with departments to develop processes that eliminate billing edits related to revenue integrity functions.
Stays current on government regulatory changes and proposals affecting charging, reimbursement methodologies, and payment systems.
The University of Vermont Medical Center aims to be a national model for high-quality academic health care in a rural region. They ensure equal employment opportunities, basing decisions on job-related criteria without discrimination.
Responsible for coding procedures and entering charges to comply with regulations and internal policies.
Coordinate with Practice Coordinator and Revenue Integrity to assure all necessary documentation is present.
Participate in audits to evaluate if all selected codes are accurate and develop methodologies to improved coding issues.
Northside Hospital is an award-winning and state-of-the-art hospital that is continually growing. They are expanding the quality and reach of their care to patients and communities which creates more opportunity for healthcare professionals in Atlanta and beyond.
Responding to high volume inquiries via email/phone
Assist with triaging case volumes
Providing resolution guidance/support to care center staff on complex claims/billing inquiries; claim holds, overrides, take backs, corrected claim workflows, coding assistance
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. The Privia 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.
Accurately assigning ICD-10, CPT, HCPCS, ASA, and modifiers for infusion services.
Reviewing medical documentation to ensure proper coding and compliance.
Staying up to date with third-party payer regulations and compliance guidelines.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions. They are committed to exceptional care and empower their team to thrive while living their core values.