Review, analyze, and complete pre- and post-payment claim audits and appeals in accordance with client policies, CMS guidelines, and healthcare industry standards.
Apply clinical judgment to evaluate documentation and determine the appropriateness and accuracy of claims.
Analyze healthcare claims, reimbursement information, and supporting documentation to identify discrepancies and potential payment issues.
Our partner company focuses on ensuring healthcare claims are reviewed accurately, consistently, and in accordance with applicable policies and industry standards. It is a collaborative, fast-paced, and evolving environment with opportunities for professional development and career advancement.
Review medically complex claims, pre-authorization requests, appeals, and fraud and 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, we empower clients with tailored solutions, operating with integrity and collaboration.
Review medical records to develop concise clinical reviews supporting authorization and reimbursement.
Facilitate communication with payors to ensure appropriate utilization management decisions.
Collaborate with interdisciplinary team to prevent denials and optimize patient care.
West Virginia University Health System is West Virginia’s largest health system, providing comprehensive healthcare services. With over 35,000 employees and 25 hospitals, it is the state's largest employer and offers a collaborative, patient-centered culture.
Conduct complex medical review of Medicare claims for Inpatient Rehabilitation Facility services.
Perform pre-claim review determinations and evaluate Additional Documentation Request responses.
Communicate determinations to providers and meet production-driven turnaround requirements.
Broadway Ventures is a small business that provides program management, technology, and consulting solutions to government and private sector clients. As a Service-Disabled Veteran-Owned Small Business, they emphasize integrity, collaboration, and excellence.
Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Review medical records and supporting documentation to confirm appropriate billing and apply CMS guidance, coding guidelines, and MUE/NCCI edits.
Prepare appeal responses using applicable coding guidance and assist with new concept development and claim selection criteria.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve access to healthcare. It is a dynamic growing organization with a collaborative and innovative work environment.
Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient and outpatient claims.
Conduct in-depth claims analysis using coding principles and electronic health information systems to ensure assigned codes are supported by documentation.
Meet quality and production standards and ensure compliance with quality management systems and ISO requirements.
Empower AI provides AI for government, helping federal agencies transform their workforce. With three decades of experience in Health, Defense, and Civilian missions, it is headquartered in Reston, VA and recognized as a 2024 Military Friendly Employer.
Perform comprehensive chart reviews to ensure documentation supports accurate HCC reporting.
Identify claims correction opportunities and submit them for processing.
Provide provider education and analyze coding trends for assigned medical groups.
Dignity Health Medical Foundation is a California nonprofit providing comprehensive health care services across the state. As part of Dignity Health, one of the largest U.S. health systems, it emphasizes purposeful work and staff growth.
Perform clinical reviews for medical necessity, level of care, and authorization compliance.
Prepare and submit high-quality appeals related to DRG downgrades and clinical validation denials.
Apply payer-specific guidelines and document review findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable revenue cycle solutions and clinical expertise. The company builds long-term careers by investing in team members' professional development and personal growth.
Conduct quality assurance and audit planning for the WTC Health Program, reviewing claims and analyzing data to identify trends and issues.
Research federal payer coverage policies and develop program policies and procedures, maintaining the health plan codebook.
Collaborate with clinicians and subject matter experts to support medical management and claims review, ensuring accurate application of medical coding standards.
Advanced Technologies & Laboratories International (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit for the World Trade Center Health Program. The company offers a competitive total compensation package including paid leave, medical, dental, vision, and a 401(k) retirement plan.
Conduct medical necessity reviews for inpatient admissions and post-acute services using evidence-based guidelines.
Lead peer-to-peer discussions with attending physicians to clarify clinical documentation and support appropriate care decisions.
Collaborate with utilization management and care management teams to ensure consistent, cost-effective care.
Our partner company provides utilization management services for Medicare Advantage members, focusing on evidence-based clinical decision-making. It operates with a collaborative, matrixed team and emphasizes regulatory compliance and patient-centered care.
Performs clinical evaluations on disability claims to substantiate medical necessity for absence.
Communicates with employees and providers to discuss clinical status and provides follow-up recommendations.
Acts as a clinical resource to claims examiners, ensuring accurate medical terminology and claim decisions.
Sedgwick is the world's leading risk and claims administration partner, helping clients navigate the unexpected with AI-enabled technology and expertise. With over 33,000 colleagues and 10,000 clients across 80 countries, they've been recognized as a Great Place to Work and offer a caring culture.
Conduct comprehensive forensic examinations of medical records and billing to identify inaccuracies or fraud.
Serve as an expert witness in legal proceedings, providing testimony on medical coding and billing.
Stay updated on regulations and collaborate with legal and compliance teams.
J.S. Held is a global consulting firm that combines technical, scientific, financial, and strategic expertise to advise clients. The firm offers a dynamic, high-energy, collaborative environment that rewards hard work.
Resolve disputed medical claims and investigate billing discrepancies.
Work with medical staff, payers, and external agencies to resolve claim issues.
Maintain accurate billing records and ensure compliance with Medicare, Medicaid, and third-party payer requirements.
The company is a healthcare organization seeking a Biller to handle medical billing and claims resolution. The culture emphasizes accuracy, professionalism, and organization in a remote setting.
Review and interpret medical records to assign accurate ICD-10, CPT, and modifier codes for inpatient and outpatient encounters.
Collaborate with physicians and providers to resolve documentation gaps and strengthen coding accuracy.
Support audits, provider education, and revenue cycle performance through quality reviews and consistent productivity.
Jobgether uses AI-powered matching to connect candidates with hiring companies. They operate globally and focus on efficient recruitment through technology.
Reviews, analyzes, and validates diagnostic and procedural codes for reimbursement and billing purposes.
Abstracts accurate information from the electronic health record to support patient care evaluation and administrative decision making.
Ensures compliance with established coding guidelines, third-party reimbursement policies, and regulatory requirements.
Henry Ford Health is a leading academic health system providing a comprehensive continuum of care, from primary and specialty care to virtual care, pharmacy, and health insurance, across Michigan and around the world. With 12 hospitals and hundreds of ambulatory care locations, the organization is grounded in purpose, collaboration, and belonging, empowering team members to grow their careers and make a meaningful difference.
Lead complex hospital and professional billing compliance audits and investigations to identify risks and ensure regulatory alignment.
Analyze billing, coding, and operational data to uncover systemic issues and provide actionable recommendations to leadership.
Serve as a billing compliance subject matter expert, advising cross-functional teams and developing training and policies.
The company is a healthcare organization focused on billing compliance and risk management, providing auditing and advisory services. It offers a remote-first collaborative environment with opportunities to influence policies and work with senior leaders.
Complete final review of medical records and select appropriate ICD-10 and CPT codes within 4 days of patient discharge.
Review documentation to match codes with medical necessity and assign working diagnoses and DRGs.
Collaborate with Clinical Documentation Specialists to identify and address documentation deficiencies.
UAMS is Arkansas' only comprehensive academic health sciences center, combining education, research, and clinical programs. It fosters a collaborative culture focused on improving patient care and supporting teamwork and diversity.
Review and evaluate denied claims using proprietary software to determine correct reimbursement.
Research and acquire medical records and supporting documentation for submission to payers.
Conduct telephone follow-up with payers to ensure prompt reimbursement.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations using an intelligent automation platform. The company has over 24 years of industry expertise, is a multi-year Top Workplaces award recipient, and has been on the Inc. 5000 list for eleven years.
Provide professional fee coding services across one or more medical specialties, accurately assigning codes.
Review clinical documentation and assign diagnosis and procedure codes to the highest level of specificity.
Work independently in a remote environment while maintaining required productivity and accuracy standards.
The company provides professional fee coding services across medical specialties. They seek a detail-oriented coding specialist to work independently in a remote environment.
Perform clinical medical record review and abstraction to support healthcare quality and compliance.
Apply established review criteria consistently and document findings clearly and objectively.
Work independently to complete accurate reviews within project deadlines while managing multiple priorities.
Health Services Advisory Group (HSAG) is transforming the delivery of healthcare in the United States. They are a growing team dedicated to improving healthcare quality, with a focus on community and collaboration.