Perform concurrent medical record reviews on nursing units to clarify patient documentation.
Prompt physicians to resolve missing, unclear, or conflicting documentation for appropriate reimbursement.
Provide education to patient care providers on clinical documentation standards and coding requirements.
Virginia Mason Franciscan Health provides a full spectrum of health care services across the Puget Sound region, with a legacy of compassionate care and innovation. With 10 hospitals and nearly 300 care sites, the organization is dedicated to healing the whole person through rigorous research, education, and collaboration.
Conduct QDI review of assigned inpatient cases and identify clinically supported documentation opportunities in real time.
Communicate directly with physicians and APPs on documentation and quality risk adjustment gaps.
Manage daily review queues and support provider education and calibration activities.
Tendo builds software that improves the care journey for patients, clinicians, and caregivers. It is a fast-growing, mission-driven company recognized as a Forbes Top Startup Employer, with a culture that enables teams and individuals to thrive.
Review psychiatric clinical documentation against Headway's quality standards to ensure safe, evidence-based care.
Provide coaching and remediation to providers on documentation and clinical decision-making.
Work with AI-assisted review tools to evaluate outputs and improve quality rubrics.
Headway builds software that helps mental health providers manage their practices and accept insurance, making therapy more accessible. They are a Series D company with $325M+ in funding, supporting over 75,000 providers across all 50 states.
Perform quality audits on clinical documentation across clinical departments.
Collaborate with leadership to develop corrective action plans and provide 1:1 coaching.
Support organizational readiness for NCQA and other regulatory audits.
Oscar is the first health insurance company built around a full stack technology platform, focusing on serving members with a concierge-level experience. It started in 2012 and is an Equal Opportunity Employer cultivating an authentic, inclusive environment.
Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance.
Review up to 25 diagnoses and procedures per record, classify errors with references.
Deliver facility audit reports and lead training sessions for coding staff and clinicians.
Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach.
Conduct internal and external quality audits for ICD-10 code abstraction and identify clinical documentation improvement opportunities.
Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data and reviewing Risk Adjustment coding performance.
Maintain compliance with national coding standards and support CMS and Risk Adjustment Data Validation audits.
Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving its members. Founded in 2012, it cultivates an inclusive environment where employees can be their authentic selves.
Audit inpatient medical records to validate ICD-10-CM/PCS coding, DRG assignments, and compliance.
Identify documentation gaps and develop compliant physician queries while collaborating with physicians.
Maintain productivity of at least three chart reviews per hour and complete accurate audit workpapers.
The hiring company provides clinical documentation improvement consulting services to healthcare organizations, focusing on accurate coding, compliance, and reimbursement. It fosters a collaborative, people-first environment and has been recognized as a Great Place to Work for three consecutive years.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established coverage guidelines.
Educate teams on medical review processes and support quality control activities.
Broadway Ventures is a veteran-owned small business delivering mission-critical support to federal health and defense customers. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, it is built on integrity, collaboration, and excellence.
Review clinical documentation and decision-making to identify gaps in care quality.
Provide coaching and remediation to clinicians to improve documentation standards.
Evaluate AI-assisted review outputs and contribute to quality process improvements.
The partner company is a healthcare organization dedicated to promoting safe, evidence-based mental healthcare through clinical quality review and education. It leverages AI-assisted tools and collaborates with experienced licensed therapists to support provider excellence.
Perform medical reviews and utilization management to determine medical necessity for services and appeals.
Evaluate medical records and document decisions using clinical guidelines and protocol sets.
Educate members, providers, and staff on coverage determinations, medical terminology, and coding procedures.
Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. As part of BlueCross BlueShield of South Carolina, we've served clients for 70+ years and offer training and tuition assistance.
Conduct thorough medical record reviews for assigned patient population to ensure accurate DRG assignment and severity of illness documentation.
Author and manage compliant provider queries to resolve documentation gaps while adhering to AHIMA and ACDIS guidelines.
Educate multi-disciplinary care teams on documentation best practices and collaborate with HIM coding professionals to streamline workflows.
CommonSpirit Health is a large nonprofit Catholic healthcare organization that provides integrated health services. It has over 157,000 employees and delivers more than 20 million patient encounters annually, striving to create a more just and equitable healthcare system.
Conduct detailed medical record audits to assess coding accuracy, documentation quality, and regulatory compliance.
Interpret CMS and payer guidance to identify compliance gaps and provide actionable recommendations.
Prepare audit reports and deliver provider education to improve billing accuracy and reduce risk.
This role is with a partner company specializing in healthcare compliance and coding audits for diverse healthcare settings. The collaborative, client-focused environment values analytical thinking, professional integrity, and continuous learning.
Conduct clinical documentation reviews to ensure compliance with coding guidelines and regulations.
Provide education and training to providers and coding staff on documentation standards.
Analyze data and report findings to leadership to improve coding accuracy.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It has been recognized as a Top 150 Place to Work in Healthcare and fosters a culture of belonging.
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.
Independently audit professional-fee coding for accuracy, compliance, and reimbursement impact.
Evaluate ICD-10-CM, CPT, HCPCS Level II, E/M services, modifiers, and professional components.
Prepare reports, deliver coding education, and maintain 95% audit accuracy.
A large regional healthcare network providing medical services across multiple facilities. The culture emphasizes independent auditing, high accuracy, and collaborative compliance education.
Perform clinical reviews to evaluate medical necessity, level of care, and benefit coverage for members.
Apply internal policies, MCG, and NCCN guidelines to deliver timely and compliant utilization management decisions.
Escalate complex cases and build audit-ready documentation for Medical Director review.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. Their mission-driven culture empowers diverse perspectives to drive real impact on people's health.
Monitor coding prevalence and ensure compliance with CMS audit processes.
Conduct provider and coder level reviews to ensure accurate risk adjustment data submission.
Maintain tracking tools and assist in RADV audits and corrective action plans.
Alignment Health is a healthcare organization dedicated to transforming senior care, focusing on the chronically ill and frail. The company is fast-growing with a passionate team united in the mission to put seniors first.
Conduct clinical and billing reviews of claims, itemized bills, and UB-04 forms to ensure accuracy.
Perform utilization reviews to assess medical necessity and validate charges against policies.
Mentor reviewers, meet productivity targets, and maintain active RN licensure with CEUs.
Our partner is a healthcare services company that conducts medical claims and utilization reviews to ensure accurate billing and appropriate care. They offer a collaborative, quality-focused remote environment with opportunities for professional development.
You'll review AI-generated outputs for clinical accuracy, safety, and appropriateness across Headway's patient and provider products.
You'll apply and refine evaluation rubrics, documenting your clinical reasoning and collaborating with peers on ambiguous cases.
You'll work with Clinical and Product teams to turn feedback into rubric and model improvements, ensuring high standards before launch.
Headway builds a new mental healthcare system that automates insurance admin and gives therapists tools to run their practice. We are a Series D company with $325M+ in funding, supporting 85,000+ providers and 1M+ patients across all 50 states.
Lead clinical quality assurance and professional development across the therapy team while maintaining a direct care caseload.
Provide clinical supervision, conduct chart audits, and mentor clinicians to ensure the highest standards of evidence-based care.
Fully remote role requiring a PA LCSW with a passion for raising clinical standards and coaching providers.
Blackbird Health is a clinician-founded and operated organization delivering virtual and in-person mental health services to children and families across multiple states. They take a whole-child approach and foster a collaborative, supportive, and innovative team culture.