Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and handle over 12 million prior authorization requests annually. The Coherenauts who succeed here are empathetic teammates who are candid, kind, caring, and embody their core values and principles.
Improve key performance metrics for the focused area within the revenue cycle.
Conduct audits of all revenue cycle processes, vendors, and technology.
Determine root cause of issue and appropriateness of actions taken, assist in corrective action plan development.
ATI Physical Therapy partners with business leaders to improve healthcare. They focus on positive change throughout the revenue cycle and offer competitive benefits.
Assist team on a smooth end-to-end billing process
Investigate, document, and follow up on denials and underpayments
Complete recurring work queues on a monthly basis
Omada Health is reverse engineering healthcare delivery, focusing on the space between doctor visits. They offer virtual-first models with human-led care teams, connected devices, and AI to support chronic conditions and have served over two million members across 2,000+ organizations.
Perform inpatient coding audits and review services remotely.
Identify trends and suggest corrective action plans.
Provide in-service education to clients on coding trends.
UASI has over 40 years of experience and enduring partnerships with its valued clients. The company was recognized as a Top Workplace by the Cincinnati Enquirer in 2022, 2023 and 2024, with a dedicated team and long-term success.
Onboard teams to train their entire RCM staff on billing best practices.
Provide reporting training, particularly in the areas of accrual accounting and AR.
Establish and nurture relationships with client stakeholders and billing personnel.
Prompt is revolutionizing healthcare by delivering highly automated and modern software to rehab therapy businesses, teams, and patients. As the fastest growing company in the therapy EMR space, they are looking to bring on a Senior Billing Success Manager.
Conducting collection activity on appealed claims by contacting government agencies and third party payers.
Requesting additional information from Patients, Medical Records, and others as needed.
Reviewing contracts and identifying billing or coding issues and requesting re-bills, secondary billing, or corrected bills as needed.
Sutherland helps strengthen brands by improving customer experiences. They're a global company with nearly 40,000 employees across over 100 countries, focusing on customer care and delivering extraordinary service.
Review patient documentation for accuracy and qualification.
Create claim and/or invoice by confirming sales order.
Monitor Patient billing module and update information as needed.
Cala Health is dedicated to freeing people from the burden of chronic disease by creating non-invasive prescription therapies. They currently have thousands of employees and strive to empower people to get back to their lives with confidence and ease.
Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Accountable to meet and maintain established department production and quality standards.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Conduct coding audits to ensure accuracy and compliance with coding guidelines.
Identify compliance risks and recommend corrective action plans.
Provide education and training to physicians and staff on coding best practices.
Theoria Medical is at the forefront of healthcare innovation and quality, offering a blend of medical excellence and technological advancements, primarily serving the post-acute sector. Their network includes multispecialty physician services across skilled nursing facilities nationwide, fostering a mission-driven culture that values expertise and innovation.
Own the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
Design and oversee a robust audit program that monitors adjudication system output against clinical policies, pricing, benefit rules, and provider contract terms.
Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies and contract validation.
Clover Health aims to improve the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They are a mission-driven team of individuals, who are passionate about solving healthcare's most complicated problems, and strive to put members first.
Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
Review provider documentation and assign accurate codes per ICD-10-CM, CPT, and HEDIS/quality reporting guidelines.
Maintain and contribute to the internal billing rules matrix (payer, state, provider type, modifiers).
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that reimagines care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care. They enhance existing care teams with compassion, creativity, and an unwavering commitment to children with medical complexity.
Manage a high volume of patient-facing and internal billing questions.
Work claims end-to-end via our clearinghouse, partnering with stakeholders.
Support efforts to streamline existing RCM processes and ad-hoc RCM projects.
Nourish is on a mission to improve people’s health by making it easy to eat well. They are building an AI-native, patient-friendly healthcare system centered on nutrition. They have 100s of 1000s of patients and 1000s of dietitians on their platform and have raised $115M from top-tier VCs.
Conduct audits of medical coding to ensure compliance with standards.
Develop and deliver education to improve documentation quality and coding accuracy.
Assist with internal and external audit preparation and response.
Sprinter Health reimagines how people access care by bringing it directly into their homes. They have supported more than 2 million patients across 22 states, completed over 130,000 in-home visits, and maintained a 92 NPS.
Audits clinical documentation and coding for inpatients, emphasizing mortality reviews to identify improvement opportunities and ensure compliance with guidelines.
Collaborates with clinical teams and medical staff as an expert educator to develop strategic plans and teaching tools that improve quality metrics and outcomes.
Manages advanced project work including Risk Adjustment and Quality Abstraction, while partnering with departments like IT and Analytics to design new workflow solutions.
Northwestern Medicine is a leader in the healthcare industry focused on a patient-first approach to cultivate a positive workplace. The organization provides competitive benefits like tuition reimbursement, loan forgiveness, and 401(k) matching to take care of its employees as part of a large health system.
Participate in end-to-end implementation activities.
Develop an understanding of Experian Health's product suite and apply best‑practice workflows.
Facilitate requirements gathering, workflow mapping, configuration reviews, and user acceptance testing.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange, they have a team of 23,300 people across 32 countries.