Lead pre-live and post-live athenaOne Collector/billing training to providers, administrative and billing staff in all markets
Innovate and create new learning experiences for Care Centers for Privia University (LMS).
Provide excellent customer service through creative problem solving and follow through
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. They are led by top industry talent and exceptional physician leadership.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
Perform coding audits and reviews on a variety of professional fee record types.
Perform necessary research in order to provide the client with supportive regulatory and coding guideline documentation.
Assist in the design and presentation of educational seminars to clients and staff
UASI is an award-winning company with over 40 years of experience, offering consulting services. We have enduring partnerships with our valued clients, stability, and long-term success of our dedicated team.
Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.
Conduct advanced, strategic analysis of paid claims, uncovering critical audit insights that drive process improvements and enhance organizational knowledge.
Make determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance.
Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. They are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth.
Conduct chart audits for patient encounters, ensuring accurate medical record documentation.
Identify opportunities to improve documentation quality and clinical compliance.
Support the contact center by addressing patient questions and providing education.
Planned Parenthood South Atlantic provides reproductive health care. They are committed to equitable and transparent pay practices and value their employees.
Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types
Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans
Perform necessary research to provide to the client to support findings.
UASI is recognized as a Top Workplace. With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we’ve built and the long-term success of our dedicated team.
Assess the quality of the performance of our end user Service Desk.
Monitor Service Level Agreement (SLA) metrics and assess technical accuracy, customer service performance, and conformity to company policies and procedures.
Assist in developing, creating, and implementing quality processes and procedures; as well as making recommendations for the overall program to enhance the customer experience.
AMERICAN SYSTEMS is dedicated to innovation and customer success. They offer expanded resources, streamlined operations, and increased opportunities for growth and development.
Conducts audits of clinical documentation reviews to ensure compliance and regulatory requirements.
Develop and deliver training sessions based on audit findings to support CDI team competency.
Oversee the accuracy, specificity, and completeness of clinical documentation.
Adventist HealthCare is a faith-based, not-for-profit organization dedicated to improving the health and well-being of people and communities. They employ over 6,000 professionals and are one of the longest serving healthcare systems in the Washington, D.C., area.
Serve as a subject matter expert and coach to QA staff and leaders across multiple states, promoting consistent quality practices and continuous improvement.
Facilitate regular meetings with state QA leaders to review performance goals, challenges, and improvement opportunities.
Analyze QA metrics, KPI dashboards, and audit findings to identify trends and areas for operational improvement.
Dungarvin is dedicated to enhance the quality of life for people with intellectual and developmental disabilities, including those with mental health, behavioral, or complex medical needs. Dungarvin has services nationwide, and is united by a shared commitment to making a real difference.
Conduct audits comparing medical record documentation to reported codes.
Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.
Provide feedback, education, training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision and coding principles.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. Their platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Perform audits to assess the quality of documentation, accuracy of charge code assignment and review financial billing statements.
Answer any physician and/or clinic questions and concerns regarding current ICD-10 and CPT guidelines.
Provide coding training and updates for coding staff, physicians and clinics as assigned.
Shirley Ryan AbilityLab is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions. They have an innovative, multifaceted culture that embraces collaboration, excellence, discovery, and compassion.
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Machinify is a healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They deploy a configurable, AI-powered platform and best-in-class expertise, serving over 85 health plans representing more than 270 million lives.
Perform in-depth quality audits on customer support calls and email cases.
Ensure accuracy of information and professionalism in customer interactions.
Propose documentation updates to enhance the Customer Service Representative (CSR) experience.
Evry Health aims to bring humanity to health insurance with high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach. They are the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, more than 3,000 corporate employees and 15,000 agents.
Ensure the highest level of quality in customer support interactions and internal processes.
Contribute to improving customer satisfaction, agent performance, and operational efficiency.
Monitor and provide feedback to improve customer and patient satisfaction.
Privia Health is a technology-driven, national physician enablement company. They collaborate with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences.
Own the execution of clinician chart audits and watchlist tracking.
Investigate clinical incidents, chart audits, and collaborate on root cause documentation.
Track quality, safety, and clinician performance metrics using manual and automated tools.
Wheel is evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. They offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.
Review and validate AI-generated responses, knowledge articles, and case resolutions.
Create, test and validate automated workflows across Salesforce Service Cloud, Jira, and Wrike.
Analyze CSAT, NPS, and case resolution data to identify trends and quality issues.
Granicus builds and maintains technology that transforms the Govtech industry by bringing governments and constituents together. They have served 5,500 federal, state, and local government agencies, and over 300 million citizen subscribers use their digital solutions across the U.S., U.K., Australia, New Zealand, and Canada.
Collaborate with audit team members as well as members of IT to develop audit objectives, engagement scopes, and testing strategies aligned with departmental standards and risk priorities.
Assist in the planning, execution, and reporting of IT audit engagements, including SOX ITGC testing, risk-based technology reviews, and issue validation procedures.
Analyze and summarize data to identify control deficiencies, process inefficiencies, or noncompliance with policies, procedures, or regulations.
Pathward is a financial empowerment company that works with innovators to increase financial availability, choice, and opportunity for all. They are a team of problem solvers and innovators who celebrate differences and believe that unique perspectives make them stronger and well-positioned for success.
Serve as a subject matter expert for front-end revenue cycle functions.
Investigate and resolve complex billing issues that prevent claims from being successfully accepted by payers.
Conduct root cause analysis on recurring front-end issues and implement process improvements to reduce claim errors and rework
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions.
Responsible for ensuring that the Value Hub adheres to regulatory standards, contract requirements, and internal quality benchmarks.
Analyzing compliance data, preparing detailed reports, and working closely with various departments to maintain and improve compliance and quality standards.
Supporting the understanding of local regulatory requirements, completion of local audits, participation in quality committees, and supporting health plan needs and interactions to ensure consistent implementation of contractual obligations.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside their hospitals and out in the community.