Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition.
Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG. Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed.
Works with Coders and CDSs to draft and initiate physician queries.
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Machinify is a healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They deploy a configurable, AI-powered platform and best-in-class expertise, serving over 85 health plans representing more than 270 million lives.
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.
Ensuring the accuracy, integrity, and quality of coding practices within the HIM department.
Conducting thorough reviews of clinical documentation, coding, and billing processes to ensure compliance.
Educating and training coding staff on best practices and updates in coding guidelines.
Cooper University Health Care is committed to providing extraordinary health care. They focus on clinical innovations and access to facilities, equipment, technologies and research protocols, and offer competitive rates, compensation programs, benefits, and career growth.
Review and analyze medical records to ensure coding accuracy in a timely fashion
Identify opportunities for improvement in coding models
Understand and apply coding guidelines to assign appropriate codes to diagnoses and procedures as supported by clinical documentation
SmarterDx builds clinical AI that is transforming how hospitals translate care into payment. Founded by physicians in 2020, their platform connects clinical context with revenue intelligence, helping health systems recover millions in missed revenue, improve quality scores, and appeal every denial.
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.
Assigns ICD-10-CM/PCS codes and assigns DRGs for inpatient medical records accounts; assigns ICD-10-CM/PCS codes and CPT codes for outpatient medical record accounts
Abstracts key data elements required for billing
Interacts with providers for clarification of documentation/education
UChicago Medicine has been at the forefront of medicine since 1899 and provides superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, they need employees with passion, talent and commitment… with patients and with each other.
Northeast Georgia Health System (NGHS) is a non-profit organization dedicated to improving community health through various initiatives. With a team of caregivers serving over 1 million people across the region, NGHS consists of five hospitals and numerous outpatient facilities.
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.
Organizes and prioritizes assigned work to ensure completion within the assigned time frame.
Reviews charts and medical records, assigning ICD and CPT code combinations to each data element.
Audits for documentation opportunities and queries clinical staff to fill in any gaps.
Riverside Health System's mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team, offering care at all stages of life, in hundreds of locations.
Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types.
Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures
Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
Northwestern Medicine is committed to a patient-first approach, setting them apart as a leader in healthcare. They pride themselves on providing competitive benefits, from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, aiming to care for their employees.
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.
Codes and abstracts Outpatient records for data retrieval, analysis, reimbursement and research.
Enters diagnostic and procedure codes into a designated coding and abstracting system utilizing the 3M encoder.
Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR.
CommonSpirit Health has more than 700 care sites across the U.S. Their combined resources are committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen both inside our hospitals and out in the community.
Review clinical documentation and assign accurate ICD-10-CM, HCPCS, and CPT codes to encounters
Ensure compliance with CMS, payer, and risk adjustment coding guidelines
Collaborate with clinicians and billing staff to clarify documentation or coding discrepancies
Main Street Health is the nation's largest provider of value-based care exclusively serving rural America. They partner with rural primary care doctors and reinforce the importance of trust and relationship-driven care in rural communities.
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.
Perform comprehensive reviews of patient charts to identify gaps in documentation.
Collaborate with providers and clinical staff to educate them on accurate documentation.
Maintain accurate records of chart reviews, coding opportunities identified, and outcomes.
Bluestone delivers exceptional care to patients living with complex, chronic conditions and disabilities. Our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver preventative, proactive and tailored care. Bluestone has been named to the Star Tribune's Top Workplace list for the 13th year in a row and also achieved Top Workplace USA 2021-2025!
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.