Review and analyze CDM data to ensure accuracy and compliance.
Conduct regular audits to identify discrepancies and areas for improvement.
Work with clinical, billing, and coding teams to resolve charge capture issues.
LCMC Health is a community-focused healthcare provider deeply rooted in New Orleans, Louisiana. They are committed to providing exceptional care and education, with a culture that celebrates authenticity, equity, and inclusion.
Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes.
Collaborates with and leverages Segment Specialist expertise to ensure on-point results and ensure training material updates as necessary.
Conduct research, identify impact on existing concepts, and document accordingly and support activities required to package concepts.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plans. They are deployed by over 75 health plans, representing more than 170 million lives, and use an AI operating system, combined with expertise, to untangle healthcare data.
Validate curated content against authoritative source documentation.
Identify inaccuracies, inconsistencies, or gaps in curated content.
Partner with content and QA team members to resolve questions.
TruBridge Encoder delivers enterprise-grade healthcare coding solutions as part of TruBridge’s Financial Health division. Their teams operate with a high degree of independence, using modern tools and practices to exceed customer expectations.
Performs final reconciliation on clinic/provider visits, resolving documentation issues.
Reviews, abstracts, and codes multiple services and complex cases, assigning classifications.
Researches/resolves high volume accounts/claims and educates staff on guidelines.
University of Utah Health is a patient-focused organization with a mission to enhance the health and well-being of people through patient care, research, and education. They have five hospitals and eleven clinics and are known as a Level 1 Trauma Center, nationally ranked for academic research and patient experience.
Conduct in-depth analysis of claim payments, identifying trends and patterns for cost avoidance through internal and external collaboration.
Ensure medical claims comply with guidelines, contracts, and standards while detecting billing inefficiencies and recommending corrective actions.
Provide data-driven recommendations to management on payment-affecting issues, supporting necessary system and policy updates and provider education.
BCBSRI is dedicated to serving Rhode Islanders by providing access to high-quality, affordable, and equitable care. They actively support associate well-being and work/life balance, fostering a culture of belonging where diverse perspectives are valued and employees are equipped for success.
Responsible for decision-making and coding reviews.
Facilitate, obtain, validate, and reconcile appropriate provider documentation.
Ensure accurate reflection of illness severity and patient care complexity.
Millennium Physician Group (MPG), formed in 2008, is the largest independent physician group in Florida and one of the largest in the United States. They provide employees with the tools to succeed, a team atmosphere, and opportunities for growth.
Utilizing healthcare experience to perform audit recovery procedures.
Identifying and validating incorrect claim payments.
Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings.
Cotiviti Healthcare is the payment accuracy expert, working with healthcare organizations to recover money, improve processes, strengthen relationships, and maximize their value. They are a well-established company with competitive pay, opportunities to develop professionally, and excellent benefits.
Collaborates with clinical documentation team to review inpatient accounts.
Assesses DRG, PDx, secondary Dx, PCS, POA and all documentation components impacting quality metrics.
Continually assures coding practices remain compliant with coding guidelines and regulations.
Northwestern Medicine strives for a positive workplace for every patient interaction. They are a leader in the healthcare industry, offering competitive benefits such as tuition reimbursement, loan forgiveness, and 401(k) matching.
Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Assess and Analyze daily charge activity for assigned area.
Works with the Revenue Integrity Manager on quality assurance and auditing of charge activity within IHIS.
Anesthesia Reconciliation; analysis of charge sessions for submission to Central Coding Department for revenue capture.
Ohio State University Physicians (OSUP) provides exceptional patient care while fostering a collaborative work environment through over 100 outpatient center locations. OSUP fosters a culture grounded in the values of inclusion, empathy, sincerity, and determination, with a team including more than 1,800 employees.
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Develop and maintain a deep understanding of our RCM/Clearinghouse capabilities to effectively respond to incoming customer inquiries.
Resolve common support ticket inquiries in a timely manner, such as clearinghouse rejections and ERA/EDI Application Help
Improve and advocate for customer experience by identifying opportunities to enhance our enrollment process and provided EDI/ERA support
Prompt Therapy Solutions is revolutionizing healthcare by delivering automated software to rehab therapy businesses and patients. As the fastest growing company in the physical therapy EMR space, they are looking to bring on people to help contribute to the continued growth.
Responsible for conducting medical records and coding related reviews to validate the integrity of coded procedures.
Works closely with clinical departments and Revenue Cycle Services to ensure compliance with coding guidelines, government, payer and internal charge capture policies.
Provides education and training to clinical providers and staff within the practices on proper documentation and coding guidelines, practices and procedures.
They are committed to diversity and inclusion, welcoming all as valued members. They focus on providing the highest level of care by taking care of their incredible teams.
Design engaging training, lead coders through evolving standards, perform high level audits, and shape best practices across multiple specialties.
Conduct detailed audits to identify under coding, over coding, documentation gaps, and compliance risks.
Spot trends in documentation and coding performance and collaborate on workflow improvements.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Translates patients’ medical records into standardized codes for diagnoses and treatments.
Ensures compliance with legal, regulatory, and organizational standards.
Manages records to ensures claims are processed correctly and on time.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. They are an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada.
Collect, clean, process, and analyze potential and current clients’ pharmaceutical data using SQL, R, Python, and MS Excel.
Thoroughly understand internal and external data fields, identify patterns of data irregularities, and improve data quality and intake.
Assist in the writing and maintenance of the Underwriting infrastructure code in SQL, R, and Python.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. The company aims to rebuild trust in healthcare in the U.S. and deploy the infrastructure we need for the care we deserve; they have a startup energy with a focus on delivery.
Assigns appropriate billing codes to patient accounts.
Provides feedback to Coders on coding discrepancies.
Performs special projects and other duties as assigned.
Ventra is a leading business solutions provider for facility-based physicians. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions.
Performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record.
Trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function.
Demonstrates expertise to resolve Optum coding edits.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of the team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system.
Perform code abstraction of medical records, diagnostic imaging, etc.
Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education.
Assist by making recommendations for process improvements to further enhance coding goals and outcomes.
Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical providers, who care for more than 200,000 patients statewide. Their mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare, with a focus on preventing the nation’s top leading causes of death.
Develop, maintain, and execute complex inpatient coding audit processes.
Design and deliver clinical coding education and training programs.
Partner with staff to resolve audit findings and improve coding accuracy.
CRD Careers is a boutique recruitment agency specializing in Sales and HR placements. We connect growth-minded companies with high-impact professionals who drive real results. This company's approach is precise, people-first, and built for long-term success.