Conduct audits of payer processed claims to verify accurate reimbursement.
Conduct post-implementation Care Center audits following the audit policy.
Assist the Manager, RI, in leading initiatives that drive efficiency.
Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Their platform consists of scalable operations and cloud-based technology to reduce healthcare costs and improve patient outcomes.
Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
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. The Coherenauts who succeed here are empathetic and believe diverse, inclusive teams make the most impactful work.
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.
Source, interpret, and scope new payment integrity policies.
Prioritize policy updates based on savings potential and client impact.
Quantify and communicate policy value through data-driven analysis.
Rialtic, Inc. focuses on healthcare payment expertise, client strategy, and product innovation. They seem to have a culture that values collaboration and impact, although the job post doesn't specify size/employees.
Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
Identify and document systemic payer issues and trends affecting reimbursement.
TREND Health Partners is a tech-enabled payment integrity company. They facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment.