Review, analyze, and complete pre- and post-payment claim audits and appeals in accordance with client policies, CMS guidelines, and healthcare industry standards.
Apply clinical judgment to evaluate documentation and determine the appropriateness and accuracy of claims.
Analyze healthcare claims, reimbursement information, and supporting documentation to identify discrepancies and potential payment issues.
Develop and maintain audit concepts by researching regulatory, coding, or payer policy changes and updating rule documents and code lists.
Perform QA reviews to ensure audit concepts comply with coding standards, payment methodologies, and payer policies prior to deployment.
Collaborate with cross-functional teams including operations, clinical, and client services to support policy execution and drive concept quality.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering value and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, we are a digital-first, AI-powered platform that reimagines what's possible in healthcare.
Perform complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules.
Collaborate with operations consultants, RCM AR staff, and management to address Care Center payment performance audits and maximize cash flow.
Identify, monitor, and manage denial management trends, and work closely with Revenue Cycle Teams and payer representatives.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, focusing on reducing healthcare costs and improving outcomes.
Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Review medical records and supporting documentation to confirm appropriate billing and apply CMS guidance, coding guidelines, and MUE/NCCI edits.
Prepare appeal responses using applicable coding guidance and assist with new concept development and claim selection criteria.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve access to healthcare. It is a dynamic growing organization with a collaborative and innovative work environment.
Own first-level reviews of pre-certification requests for medical appropriateness and necessity.
Drive post-service reviews and manage the appeals process for non-certified services.
Coordinate smooth discharges and redirect care in-network to keep patients on track.
Personify Health created the first personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together in one place. Their team serves employers, health plans, and health systems with a mission to empower people to lead healthier lives.
Review medically complex claims, pre-authorization requests, appeals, and fraud and abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, we empower clients with tailored solutions, operating with integrity and collaboration.
Review healthcare claims and determine appropriate payment methodologies based on contractual terms and client requirements.
Analyze claim information and system data to ensure accurate repricing while meeting productivity and quality metrics.
Collaborate with internal audit and operational teams to support compliance, quality assurance, and process improvement initiatives.
The company provides healthcare claims review and repricing services. It operates remotely with a focus on compliance, accuracy, and continuous improvement.
Manage patient billing episodes, prior authorizations, and claim submissions.
Review and resolve claims issues, appeals, and eligibility with payors.
Ensure timely follow-up on outstanding accounts and document activities.
Acadia Healthcare's Comprehensive Treatment Centers (CTC) division operates 170+ CARF-accredited outpatient opioid treatment programs (OTPs) nationwide, serving more than 74,000 patients daily. As the leading provider of medication-assisted treatment in the nation, our team is at the forefront of the battle against the opioid epidemic.
Conduct Skilled Nursing Facility medical claims audit reviews applying medical review guidelines.
Document findings and generate articulation letters for audit results.
Collaborate with audit team and clients to improve medical policies and workflows.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare.
Review medical records to develop concise clinical reviews supporting authorization and reimbursement.
Facilitate communication with payors to ensure appropriate utilization management decisions.
Collaborate with interdisciplinary team to prevent denials and optimize patient care.
West Virginia University Health System is West Virginia’s largest health system, providing comprehensive healthcare services. With over 35,000 employees and 25 hospitals, it is the state's largest employer and offers a collaborative, patient-centered culture.
Manage client medical payment policies to ensure accuracy and compliance with CMS and payer guidelines.
Conduct periodic reviews and analyses of policy updates, coordinating with Medical Directors and presenting recommendations to clients.
Serve as the primary client liaison, addressing inquiries and maintaining detailed documentation of policy nuances.
Cotiviti is a healthcare data analytics company specializing in payment accuracy and medical policy management. The company fosters a collaborative remote culture and offers competitive benefits to support its team.
Review inpatient claims to identify missed reimbursement opportunities based on ICD-10 coding accuracy.
Analyze hospital billing files and medical records to optimize DRG reimbursement.
Collaborate with leadership on case prioritization and workflow management.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations using intelligent automation. They are a multi-year Top Workplaces award recipient and have been on the Inc. 5000 list of fastest-growing private companies for eleven years.
Audit outpatient and specialty claims to ensure coding accuracy, clinical validity, and medical necessity.
Utilize advanced coding knowledge and audit tools to identify billing issues and document findings.
Meet productivity and quality standards while recommending process improvements and new claim types.
Cotiviti is a healthcare analytics and auditing company that focuses on improving claims accuracy and reducing costs for clients. They are a mid-to-large sized employer with a culture that emphasizes quality, collaboration, and innovation in healthcare auditing.
Performs clinical quality assurance review of daily clinical validation reviews and communicates differing audit decisions to ensure accuracy.
Integrates healthcare auditing principles and uses industry knowledge to substantiate decisions, reviewing medical records and applying clinical criteria.
Serves as a mentor to other QA auditors and may flex into initial audit or appeals roles as needed.
Cotiviti provides healthcare auditing and recovery solutions to ensure high quality recoverable claims. As a company, it employs a sizable workforce and fosters a culture of compliance, accuracy, and continuous improvement through professional skepticism and mentorship.
Perform detailed DRG validation and quality audits of inpatient medical records to assess coding accuracy and clinical validity.
Review ICD-10-CM/PCS code assignment, POA indicators, SOI/ROM, HCC capture, and other reimbursement-related elements.
Support clinical documentation improvement initiatives by identifying documentation and physician query opportunities.
The partner company specializes in healthcare revenue integrity and DRG auditing. It operates with a remote team and values accuracy, compliance, and independent work.
Lead complex hospital and professional billing compliance audits and investigations to identify risks and ensure regulatory alignment.
Analyze billing, coding, and operational data to uncover systemic issues and provide actionable recommendations to leadership.
Serve as a billing compliance subject matter expert, advising cross-functional teams and developing training and policies.
The company is a healthcare organization focused on billing compliance and risk management, providing auditing and advisory services. It offers a remote-first collaborative environment with opportunities to influence policies and work with senior leaders.
Conduct independent clinical research and interpret specialty society guidelines to originate automated payment integrity logic.
Author end-to-end logic from scratch, translating clinical documentation and coding frameworks into precise parameters.
Lead cross-functional policy development and own concept rollouts from discovery through post-launch tracking.
Devoted Health is a healthcare company on a mission to improve the health and well-being of older Americans by providing a seamless care platform. Founded in 2017, it fosters a culture of innovation and collaboration, with a focus on data and AI to deliver exceptional member experiences.
Resolve disputed medical claims and investigate billing discrepancies.
Work with medical staff, payers, and external agencies to resolve claim issues.
Maintain accurate billing records and ensure compliance with Medicare, Medicaid, and third-party payer requirements.
The company is a healthcare organization seeking a Biller to handle medical billing and claims resolution. The culture emphasizes accuracy, professionalism, and organization in a remote setting.
Monitor incoming vitals and symptoms for patients with chronic conditions like hypertension and diabetes.
Triage alerts and coordinate with nurses to route flagged patients into timely care interventions.
Inspect AI-generated output for clinical accuracy and document interactions in the patient record.
Cadence is the clinical AI company automating the treatment of chronic disease, partnering with over 20 health systems and serving 100,000+ patients. Recognized by TIME as a Top 100 HealthTech Company and LinkedIn's #4 Top Startup, it fosters a culture of innovation and remote collaboration.
Act as a subject matter expert on medical payment policy, analyzing client data and presenting new policy opportunities to health plans.
Collaborate with Client Medical Directors and internal teams to develop and advocate for adoption of medical policies that maximize value.
Prepare presentations, coordinate reviews, and inspire trust as a trusted advisor for the Health Plan's medical payment strategy.
Cotiviti is a healthcare analytics company that partners with health plans to optimize payment accuracy and medical policy through data-driven solutions. The company employs a global workforce and fosters a collaborative, client-focused culture.
Own the full revenue cycle for a behavioral health practice, including charge entry, claim submission, payment posting, denial management, and collections.
Serve as the primary contact for patients and insurance payers, providing compassionate customer service and resolving billing concerns.
Prepare and present clear reports on key revenue cycle metrics to management, using Excel and PowerPoint.
Assist World connects businesses with remote virtual assistants, supporting a small, remote team culture with a focus on autonomy and results. The platform emphasizes no tracking and provides bonuses for performance.