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.
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.
Complete pre-charting and post-charting of comprehensive home health assessments in MatrixCare EMR.
Ensure documentation accuracy, compliance with regulatory standards, and strict confidentiality per HIPAA.
Collaborate with nurses to review and finalize patient records while maintaining strong attention to detail.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff through a global network. They connect clients with qualified professionals and offer tailored services to meet unique business needs.
Conduct Skilled Nursing Facility medical claims audit reviews applying medical review guidelines.
Document findings and generate articulation letters for audit results.
Collaborate with audit team and clients to improve medical policies and workflows.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare.
Oversee the Complex Clinical Bill Review team, managing production expectations, SLAs, client communication, and team performance.
Analyze and track internal business requirements, continuously evaluate functionality across programs, and perform requirements gathering to solve process issues.
Monitor team performance metrics, identify growth opportunities, and coordinate system enhancements including JIRA and UAT testing.
Machinify is a leading healthcare intelligence company providing an AI-powered platform for health plan clients. They are deployed by over 85 health plans, representing more than 270 million lives, with a culture of innovation and efficiency.
Apply specialized clinical knowledge to categorize, code, and interpret patient medical records for MBSAQIP registry.
Ensure accurate and timely submission of data across multiple registries and EMR systems.
Collaborate with hospital partners and contribute to best practices and process improvements.
Q-Centrix provides quality solutions to hospital partners by applying clinical expertise to advance patient outcomes and research. They are an established organization with a supportive culture, recognized as a Great Place to Work multiple years in a row.
Review and evaluate electronic medical records of emergency department admissions to screen for medical necessity using InterQual or MCG criteria.
Apply evidence-based clinical guidelines to assess and ensure proper utilization of healthcare resources.
Enter clinical review information into the system for transmission to insurance companies for authorization.
Netsmart provides advanced healthcare technology solutions for post-acute and human services clients, enabling better care through a comprehensive platform. We are a vision-driven team passionate about innovation, and we have been recognized as one of the best companies to work for.
Apply specialized clinical knowledge to categorize, code, and interpret registry data from patient medical records.
Ensure quality submission of data in specified registries, maintaining high accuracy standards.
Prioritize tasks, meet tight deadlines, and troubleshoot technical issues with EMR systems.
Q-Centrix partners with hospitals to deliver quality clinical data solutions, specializing in cancer registry and data abstraction. With a remote-first culture and employee-centric leadership, the company has earned the Great Place to Work distinction multiple years.
Performing timely utilization review of healthcare services using approved medical necessity criteria.
Collaborating with medical directors, providers, and internal teams for compliant review processes.
Ensuring accurate documentation and communication of determinations within regulatory timeframes.
Guidehealth is a data-powered, performance-driven healthcare company focused on making healthcare affordable and improving patient health. It is a physician-led organization using AI and predictive analytics, with a culture of accountability, growth, innovation, and empathy.
Manage the collection and organization of medical records for billing and coding support
Review documentation for completeness and accuracy, ensuring HIPAA compliance
Collaborate with internal teams to track and route records for claims and appeals
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. They focus on accuracy and efficiency in revenue cycle management, with a supportive remote work environment.
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 and label clinical data to ensure accuracy and consistency for AI training.
Provide clinical expertise on healthcare workflows and EHR documentation.
Collaborate with teams to evaluate AI outputs and improve model performance.
This company creates AI-powered healthcare solutions to advance patient care and clinical efficiency. It offers a remote, collaborative environment for experienced healthcare professionals.
Handle inbound and outbound patient calls for appointment scheduling, reminders, and follow-ups.
Document interactions accurately in electronic medical records to support continuity of care.
Coordinate with onsite healthcare personnel and healthcare teams using digital collaboration tools.
This company partners with U.S. healthcare clinics to provide remote clinical support. It offers a structured, service-focused environment with a team of nursing professionals.
Review patient records and clinical documentation to determine eligibility accurately.
Communicate with patients, clinicians, and providers to ensure a smooth onboarding process.
Maintain records in EMR systems and manage multiple cases simultaneously.
Our partner is a healthcare organization focused on improving patient access to specialized services. They operate with a remote, patient-focused team committed to efficient and compassionate care delivery.
Review medical history with patients in preparation for prescriber review.
Provide patient counseling on medication use, safety, and side effects.
Collaborate with the Customer Experience team and medical network to coordinate care.
Remedy (formerly Thirty Madison) revolutionizes healthcare accessibility by providing remote care and support. The company is building a diverse and inclusive workplace as part of a larger organization.
Conduct initial screening and triage for psychiatric and chemical dependency admissions through virtual assessment.
Utilize nursing process and telephone guidelines to provide quality care and ensure positive patient outcomes.
Collaborate with multidisciplinary team and manage multiple priorities in a fast-paced environment.
Sutter Health is a healthcare organization dedicated to providing high-quality medical services. It is a large, integrated system with a supportive culture that values employee contributions and patient-centered care.
Survey ambulatory care organizations across the United States within the scope of Joint Commission's Ambulatory Programs.
Engage health care staff in interactive dialogues to assess compliance and identify opportunities for improving care quality.
Prepare management reports that link standards deficiencies with systems vulnerabilities and communicate findings to leadership.
The Joint Commission accredits and certifies health care organizations to improve patient safety and quality of care. It employs a nationwide team of surveyors who work remotely and travel extensively.
Accurately abstracts and cleans clinical data for CMS and national registries.
Provides feedback on measures and comparative data to physicians and management.
Participates in multidisciplinary teams to identify improvement opportunities in documentation and practice patterns.
UnityPoint Health is a healthcare system focused on providing quality care and fostering a culture of belonging. Recognized as a Top 150 Place to Work in Healthcare, they offer competitive benefits and support for team members.
Provide clinical education, focused interventions, and care transition support for members with low-acuity needs.
Conduct in-person and virtual clinical exams, medication reconciliation, and chart reviews.
Triage referrals and collaborate with care team to ensure timely follow-up and handoffs.
Cityblock Health is a tech-driven provider for communities with complex needs, offering personalized primary care, behavioral health, and social services. Founded in 2017 and backed by Alphabet, the company has a diverse, inclusive culture and is growing rapidly.