Provide strategic leadership and operational oversight for CMS-mandated RADV audits across Medicare Advantage and Commercial lines of business.
Lead development of audit strategies, workflows, and performance objectives to support regulatory compliance and organizational goals.
Direct departmental operations including staff development, performance management, and cross-functional coordination to ensure successful execution of priorities.
HealthEdge provides AI-powered operational infrastructure for health insurance companies. The company is experiencing strong market momentum and investing in its people to shape the future of healthcare technology.
Lead professional billing coding and clinical documentation integrity programs across a complex health system, ensuring coding accuracy and regulatory compliance.
Oversee team operations, including staffing, performance monitoring, audit education, and continuous process improvement.
Build strong relationships with executives, physicians, and coding professionals to drive quality and reimbursement integrity.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use technology to review applications and share top-fitting candidates with employers, fostering an inclusive and efficient hiring process.
Drive operational excellence across provider risk adjustment, HCC coding, and value-based care programs while overseeing coding services delivered by domestic and global teams.
Serve as the primary strategic lead and escalation point for health plan and provider clients, maintaining accountability for service quality and client satisfaction.
Manage, mentor, and develop diverse coding teams across locations, ensuring coding activities follow organizational standards and regulatory requirements.
Our partner is a company that drives operational excellence in healthcare through risk adjustment, HCC coding, and value-based care programs. They are a senior leadership focused organization that manages coding services with diverse teams, emphasizing quality and compliance.
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.
Conduct coding audits to ensure accuracy and compliance with ICD-10, CPT, and HCPCS guidelines.
Document findings with authoritative references and support corrective actions and education.
Stay current on payer rules and flag compliance risks to senior leadership.
Alteva RCM provides expert revenue cycle management and strategic solutions for healthcare providers. They foster a collaborative team culture committed to excellence, seeking passionate professionals to grow their careers.
Apply HEDIS quality measure knowledge to ensure practices and ACOs receive credit for incentivized contract measures.
Access practices in-person or remotely to retrieve documentation and guide gap closure efforts.
Coordinate EHR system access, submit documentation to health plans, and consult with field teams on quality reporting strategy.
Aledade is a public benefit corporation that empowers independent primary care by helping practices thrive in value-based care. Founded in 2014, it is the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Perform daily audits of RCM accounts to ensure accuracy and compliance with policies.
Review documentation, billing records, and account activity to identify errors and process gaps.
Communicate quality issues and provide constructive feedback to staff and department leaders.
Our partner focuses on revenue cycle management services for healthcare organizations. They foster a remote culture centered on accuracy, accountability, and continuous improvement, with a team dedicated to quality and compliance.
Strategically coordinate and optimize the flow of coded medical record information to ensure accurate billing and reimbursement.
Review surgical coding submissions and manage denials to maximize revenue capture and compliance.
Design and deliver impactful educational programs that elevate documentation practices and coding quality.
Henry Ford Health is an academic health system providing comprehensive care across Michigan and beyond. With 12 hospitals and hundreds of ambulatory locations, the organization is a large, purpose-driven team committed to innovation and community impact.
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.
Lead, coach, and develop a team of coders, ensuring daily accuracy, productivity, and compliance.
Serve as the primary escalation point for complex coding issues, partnering with billing and clinical teams.
Monitor KPIs, manage audits, and drive revenue integrity through cross-functional collaboration.
Alteva RCM helps healthcare providers thrive through expert revenue cycle management, strategic insight, and innovative solutions. They are a dedicated, collaborative team committed to excellence, always seeking passionate professionals to grow their careers and make a meaningful impact.
Serve as an agency expert on our quality assurance program
Monitor quality reporting to identify trends and problems
Collaborate with the Director of Quality & Compliance on strategies to improve focus areas
Trellis is rewriting the insurance experience by building a tech-powered insurance agency. We are a profitable, fast-growing Series A startup backed by top venture firms, with a remote-first culture that values speed, experimentation, and intentional building.
Perform quality assurance monitoring for all departments within the call center, including Operations, Enrollments, Customer Success, and Settlements Teams.
Evaluate customer interactions across phone, social media, email, and chat, and develop metrics for excellence to measure performance.
Create and track accurate, timely quality-monitoring reports, and communicate detailed feedback to all teams.
Above Lending is a next-generation financial services company that provides customized lending solutions to help everyday Americans break the cycle of high-cost debt and achieve financial well-being. The company is growing quickly and fosters a culture grounded in compliance, ethics, and technology built around the people it serves.
Guide the organization's transition from QDM-based eCQMs to FHIR-based dQMs, ensuring alignment with US Core and QI-Core implementation guides.
Serve as AIR’s primary FHIR expert on CMS contracts, representing the organization in client meetings, technical panels, and HL7 workgroups.
Provide hands-on technical leadership and mentorship to a small team of measure developers, reviewing work products and ensuring accuracy across the full dQM lifecycle.
American Institutes for Research (AIR) is a nonpartisan, not-for-profit organization that conducts behavioral and social science research and delivers technical assistance to address pressing challenges in the U.S. and globally. AIR has a staff of over 1,800 employees and fosters a collaborative culture focused on expanding opportunities and improving lives.
Lead, mentor, and coach a team of over 50 direct and indirect reports to foster a high-performance culture.
Oversee daily Patient Service Center operations to ensure efficient, compliant, and high-quality service delivery.
Analyze KPIs, customer feedback, and operational data to drive continuous improvement and enhance patient and provider experiences.
The company provides patient support program services in the healthcare industry. The culture emphasizes operational excellence, compliance, and patient-centered care, with a large team environment.
Accurately assigns ICD-10-CM and PCS codes for inpatient CABG, Ortho, and Med cases.
Uses 3M 360 Encoder HDM to streamline coding and billing processes.
Creates compliant physician queries and reviews claims for medical necessity.
TruBridge provides innovative solutions that support both the financial and clinical sides of healthcare delivery. They foster a remote work culture that encourages employees to push boundaries and think differently.
Review OASIS documentation and plan of care to ensure compliance with regulations and accuracy.
Evaluate patient visit frequency and utilization to align with clinical needs and provider orders.
Collaborate with coding partners and escalate documentation improvement opportunities to leadership.
Graham Healthcare Group designs business and technology solutions to drive better care and outcomes in home health and hospice. As a subsidiary of a publicly traded company, they've been improving care coordination for over 20 years, focusing on patient-centered home care.