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 medical claims for government payers, applying medical review guidelines and documenting findings.
Generate letters articulating audit findings and support them during the appeals process.
Collaborate with the audit team and clients to improve medical policies and minimize appeals.
Machinify is a healthcare intelligence company providing AI-powered payment solutions for health plans. It serves over 85 health plans and more than 270 million lives, with a culture focused on innovation and reducing healthcare costs.
Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals processes to ensure compliance with payer contracts.
Educate staff, update policies and workflows, and act as a liaison between payers and local market leadership during audits.
Operationalize regulatory communications from governing bodies and document process changes for upstream and downstream teams.
Dignity Health Management Services offers integrated management and business services to healthcare providers, focusing on managed care administrative and clinical services to contain costs and improve quality. It is part of CommonSpirit Health, a large health system with a mission-driven culture centered on community and patient care.
Leads claims quality assurance strategy and execution to ensure accurate, timely payments and compliance with Medicare, Medicaid, and regulatory requirements.
Drives continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration.
Directly supervises team members, evaluates performance, and identifies training gaps to strengthen workflows.
WelbeHealth serves vulnerable seniors through shared intention, pioneering spirit, and the courage to love. It is a growing healthcare organization focused on team culture and mission.
Lead and oversee multiple healthcare audit projects, including PMV and HEDIS activities, from planning through reporting.
Supervise and mentor audit staff, manage budgets and schedules, and serve as a liaison with state Medicaid agencies.
Drive quality improvement, prepare proposals, and present results to clients and stakeholders.
HSAG is a nationally recognized healthcare quality improvement organization specializing in audits, data analysis, measure development, and survey research. The company fosters a supportive culture with work-life balance, flexible schedules, and a commitment to growing staff into future healthcare leaders.
Conduct targeted risk-based audits of high-risk diagnoses and HCCs to ensure clinical documentation supports reported diagnoses.
Deliver peer-level education and feedback to providers to improve documentation accuracy, specificity, and defensibility.
Collaborate with coding, compliance, and clinical leadership to reduce documentation risks and enhance audit readiness.
WellBe Senior Medical provides senior-focused healthcare services with an emphasis on risk adjustment and documentation integrity. The company fosters a remote, collaborative work environment and values compliance, education, and high-quality patient care.