Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Apply CMS guidance, coding guidelines, and industry standards during claim review, including hospital bill audits and itemized bill reviews.
Prepare appeal responses using applicable coding guidance and maintain required certifications and continuing education.
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. They are a dynamic growing organization promoting a collaborative and innovative work environment.
Perform detailed medical record reviews to validate DRG assignments and ensure billing accuracy.
Conduct clinical and coding audits to identify discrepancies and support cost containment.
Collaborate with quality teams and medical professionals to ensure compliance with payer regulations.
The company partners with healthcare organizations to ensure accuracy in medical coding and reimbursement. They offer a fully remote, supportive environment with comprehensive benefits and professional growth opportunities.
Performs clinical quality assurance review of daily clinical validation reviews and communicates differing audit decisions to ensure accuracy.
Integrates healthcare auditing principles and uses industry knowledge to substantiate decisions, reviewing medical records and applying clinical criteria.
Serves as a mentor to other QA auditors and may flex into initial audit or appeals roles as needed.
Cotiviti provides healthcare auditing and recovery solutions to ensure high quality recoverable claims. As a company, it employs a sizable workforce and fosters a culture of compliance, accuracy, and continuous improvement through professional skepticism and mentorship.
Review clinical documentation and assign accurate CPT, ICD-10-CM, and HCPCS codes for diagnoses, procedures, and services rendered.
Monitor outpatient coding work queues and unbilled accounts to support timely filing and claims submission, while resolving coding-related edits.
Collaborate with providers and revenue cycle teams to improve documentation, ensure coding accuracy, and maintain compliance with regulations.
Impact Advisors, LLC is a nationally recognized healthcare management consulting firm delivering Best in KLAS advisory, implementation, and optimization services. We cultivate a caring, fun, honest, and autonomous work environment with a shared mission to create a positive impact.
Conducts baseline, routine, and focused audits comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes.
Researches, interprets, and communicates federal and state laws and guidelines pertaining to CMS and Medicare.
Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs.
Perform daily audits on client data for completeness and accuracy of coding using clinical knowledge.
Respond to provider appeals and meet client turnaround time and KPI goals.
Utilize coding validation training to become familiar with claims payment policies and regulations.
Cotiviti is a healthcare analytics company that uses data-driven solutions to improve payment accuracy and quality in healthcare. The company offers a competitive benefits package and fosters a collaborative, fast-paced work environment.
Perform retrospective and concurrent Quality Assurance audits of inpatient encounters for accuracy and compliance.
Identify areas of educational opportunities and provide feedback to Coding Leadership.
Audit scope includes both government and commercial payors including RAC and ACHA.
Baptist Health is a faith-based, not-for-profit health system providing preventive and specialty care in Northeast Florida through over 200 locations and six hospitals. Recognized as a top workplace and most preferred provider for more than 25 years, it was recently named a top employer for diversity by Forbes.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote culture.
Review and validate medical codes for accuracy and compliance with ICD-10, CPT, HCPCS, and other coding systems.
Provide expert coding guidance and support to clinicians and departments, serving as a resource for complex coding questions.
Conduct coding audits, generate productivity reports, and collaborate with IT and billing teams to resolve system issues.
Mission Healthcare is a home health and hospice company serving seven states, the largest of its kind in the western United States. They emphasize a culture of compassion, accountability, respect, excellence, and service (CARES) and are committed to diversity and inclusion.
Assist with retrospective and concurrent coding for PACE Dual participants.
Conduct pre-visit chart preparations and post-visit chart reviews.
Oversee audits and participate in provider education programs to ensure compliance with CMS risk adjustment diagnosis coding guidelines.
WelbeHealth provides seniors with the opportunity to continue living in their homes through its PACE program. The company employs a collaborative interdisciplinary team approach and values diversity and inclusion.
Develop and maintain audit concepts by researching regulatory, coding, or payer policy changes and updating rule documents and code lists.
Perform QA reviews to ensure audit concepts comply with coding standards, payment methodologies, and payer policies prior to deployment.
Collaborate with cross-functional teams including operations, clinical, and client services to support policy execution and drive concept quality.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering value and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, we are a digital-first, AI-powered platform that reimagines what's possible in healthcare.
Coder III demonstrates proficiency in coding high acuity inpatient accounts and/or technical outpatient accounts.
Utilizes ICD-10-CM, PCS, HCPCS, CPT, and other coding references for accurate coding.
Supports Revenue Cycle goals for timely billing.
Cooper University Health Care is committed to providing extraordinary health care. We offer competitive rates, comprehensive benefits, and opportunities for career growth.
Manage and resolve claims rejections and denials, escalating trends as identified.
Verify patient eligibility and benefits, and coordinate with insurance payers.
Maintain compliance with HIPAA regulations and meet productivity standards.
Workit Health is an industry-leading provider of on-demand, evidence-based telemedicine care for addiction. They are a growing company with a dedicated team passionate about making judgment-free care accessible.
Perform advanced coding for outpatient surgical and observation records with 95% or above accuracy.
Monitor compliance with federal and state coding laws and coordinate billing information.
Serve as a resource and mentor to coding staff on billing policy and procedure issues.
OHSU is Oregon's only public academic health center, providing patient care, leading groundbreaking research, and training healthcare professionals. As Portland's largest employer, OHSU offers opportunities to learn and advance within a system of hospitals and clinics across Oregon and Southwest Washington.
Assign ICD-10-CM, CPT, and E/M codes for hospital-based encounters with high accuracy.
Review clinical documentation to ensure compliance with coding guidelines and payer requirements.
Collaborate with internal teams and client stakeholders while managing multiple assignments.
The partner company provides medical coding services for hospital-based care, ensuring accurate documentation and revenue cycle management. The team emphasizes compliance, accuracy, and a quality-focused culture.
Responsible for coding procedures and entering charges to comply with federal/state regulations and internal policies.
Coordinate with Practice Coordinator and Revenue Integrity to ensure all necessary documentation is present to support selected procedure codes.
Participate in audits to evaluate coding accuracy and develop methodologies to improve coding issues identified.
Northside Hospital is an award-winning, state-of-the-art healthcare system. It is continuously growing and offers opportunities for healthcare professionals.
Review and abstract professional medical records to ensure accurate code assignment.
Assign ICD-10-CM, CPT, HCPCS, and applicable modifiers following national and payer-specific guidelines.
Maintain coding quality metrics and participate in coding audits.
We reimagine how people access care by bringing it directly into their homes. We have supported over 2 million patients across 22 states, completed over 130,000 in-home visits, and raised over $125M from top investors.
Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records.
Review medical records for DRG/APC assignment, verify charge accuracy, and abstract clinical data.
Collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance.
Logan Health is a growing health system in Northwest Montana that provides quality, compassionate care through connection, service, and innovation. As a healthcare organization, they employ a team-oriented staff and value kindness, trust, collaboration, and excellence.
Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools.
Partner with data science teams to validate AI outputs and improve model performance.
Serve as a coding subject matter expert to support audit concept development and optimization.
Cotiviti is a healthcare analytics company specializing in payment integrity and data-driven solutions. The company fosters a collaborative culture and emphasizes innovation in healthcare audit and analytics.
Assign diagnostic and procedure codes using designated systems and review inpatient records for accuracy.
Identify and resolve coding edits and discrepancies to ensure claim accuracy and compliance.
Communicate effectively and meet productivity metrics to optimize revenue cycle management.
CommonSpirit Health is building a healthier future through integrated health services as one of the nation's largest nonprofit Catholic healthcare organizations. They deliver over 20 million patient encounters annually with more than 157,000 employees across 24 states, contributing over $4.2 billion annually in charity care and community benefits.