Lead prospective claim review audits related to clinical DRG coding compliance and readmissions programs.
Act as Subject Matter Expert to counsel other team members across Clover on clinical coding guidelines.
Collaborate with teams across Clover to ensure provider understanding of Payment Integrity recommendations.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most; they are passionate and mission-driven individuals.
Identifies, documents, and evaluates business risks, recommending improvements.
Prepares detailed audit reports for executive management, conveying evaluations and recommendations.
BlueCross BlueShield of South Carolina is a leading health insurance company and administrator of government contracts. They have been in business for over seven decades with strong roots in the South Carolina community and an A+ (Superior) A.M. Best rating.
Conducting inpatient coding reviews and SMART audits.
Providing feedback and education.
Detail-oriented and committed to quality, self-motivated, flexible and adaptable to change.
UASI works with top hospitals and HIM experts. They provide employees with the tools needed for professional growth and development and recognize that their employees are their greatest asset.
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.
Review and audit medical claims for accuracy and compliance.
Listen to customer service phone calls for accuracy and professionalism.
Prepare reports on audit findings and recommendations for process enhancements.
Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They focus on cost containment strategies with innovative solutions. The posting does not specify the number of employees or further details about the culture.
Own end-to-end financial modeling for CMS LEAD and other APMs.
Work directly with CMS VRDC data environments to extract, structure, and analyze Medicare claims and enrollment data.
Establish independent validation standards and ensure consistent adherence to these standards across the enterprise.
Arcadia transforms complex, diverse data into a unified foundation for health, helping organizations deliver better care, boost revenue, and lower costs. They are a team of fiercely driven individuals committed to making healthcare more sustainable.
Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types
Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans
Perform necessary research to provide to the client to support findings.
UASI is recognized as a Top Workplace. With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we’ve built and the long-term success of our dedicated team.
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.
Supports coding and documentation quality assurance.
Performs internal audits to assess compliance and quality.
Researches coding, billing, and charging compliance issues.
Presbyterian Healthcare Services is dedicated to improving the health of patients, members, and communities. They are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group, employing nearly 14,000 individuals.
Responsible for the oversight and coordination of payer audit requests.
Functions as the primary audit liaison for case management and financial services.
Keeps audit activity current, moving and prevent the organization from financial burden.
Sanford Health is a large and fast-growing not-for-profit health system in the United States. They offer development and advancement opportunities to their nearly 50,000 employees who are dedicated to health and healing.
Perform audits to assess the quality of documentation, accuracy of charge code assignment and review financial billing statements.
Answer any physician and/or clinic questions and concerns regarding current ICD-10 and CPT guidelines.
Provide coding training and updates for coding staff, physicians and clinics as assigned.
Shirley Ryan AbilityLab is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions. They have an innovative, multifaceted culture that embraces collaboration, excellence, discovery, and compassion.
Serves as principal lead on a defined number of providers for negotiation, strategy, and market intelligence.
Assist in the establishment of contract-related criteria and contracting guidelines to optimize financial performance and minimize Plan risk.
Responsible for understanding provider partners’ service needs and incorporating contract solutions to support providers and Capital Blue Cross in reaching shared goals.
Capital Blue Cross aims to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” due to their supportive colleagues and focus on professional and personal growth.
Provide advanced analytical, reporting, and problem‑resolution support across various departments.
Partner with operational, technical, clinical, and compliance teams to analyze trends and optimize processes.
Leverage technical acumen, including FACETS and reporting tools, to drive improvements and ensure compliance.
Capital Blue Cross is committed to providing exceptional service to their team and the community. They foster a flexible work environment where health and well-being are prioritized, valuing professional and personal growth through investment in training and continuing education.