Primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements.
Assist with data collection, analysis and reporting for process improvement efforts.
Plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.
Coordinate the end-to-end delivery of compliance and regulatory reporting across cross-functional teams.
Partner with Compliance and business stakeholders to gather, document, and translate reporting requirements into actionable deliverables.
Manage intake, prioritization, timelines, approvals, and delivery of recurring and ad hoc reporting requests.
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 company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and its team of Coherenauts embodies core values of empathy, candor, and kindness in a diverse, inclusive, and growth-oriented environment.
Review and audit clinical documentation for accuracy, timeliness, and regulatory compliance.
Ensure documentation meets Medicare Conditions of Participation, state regulations, and accreditation standards.
Lead and support Quality Assurance and Performance Improvement initiatives, tracking key clinical and operational indicators.
They are fixing US healthcare by building an AI-native physical care platform, starting with home health. The company is automating administrative work with AI to create a fundamentally different cost structure than incumbents, enabling them to serve more patients.
Prepare materials for ACO board meetings and assist in coordinating key events like retreats and kick-offs.
Design and implement key financial and KPI reports using business intelligence and customer relationship management tools.
Monitor compliance activities and support leadership on special projects and data requests in a rapidly changing startup environment.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. The company is the largest network of independent primary care in the United States, operating with a collaborative, inclusive, and remote-first culture.
Supervise daily activities of QA specialists across multiple operational areas.
Review completed audits for accuracy and consistency.
Conduct calibration sessions to ensure scoring alignment.
Machinify is a leading healthcare intelligence company delivering unmatched value, transparency, and efficiency to health plan clients. They are deployed by over 85 health plans and are reimagining what’s possible in the industry to maximize financial outcomes and drive down healthcare costs.
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.
Management and oversight of a quality team conducting quality assurance activities.
Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements.
Plans, organizes, and directs activities of Clinical Quality, including planning, training, and staff development.
HealthEdge is committed to workforce diversity and actively encourages all qualified persons to seek employment. They provide effective and efficient solutions to complex business problems.
Review doctor-patient messages to ensure clear, medically appropriate, and empathetic communication aligned with standards.
Ensure all communication complies with clinical guidelines, company policies, and regulatory requirements, flagging any risks.
Provide structured feedback to providers and internal teams to identify patterns and recommend improvements to workflows.
Willow is a telehealth company providing personalized, responsible cosmetic weight loss care by combining medical expertise with a patient-centered approach. The company is a diverse, global team focused on making high-quality care accessible and thoughtful.
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.
Perform ongoing synthesis and analysis of health care quality metric performance and other key performance indicators.
Develop dashboards and visual assessments of health care quality metric performance and key performance indicators using claims, administrative, and/or program data.
Provide data and analysis to leaders to inform strategic recommendations on health care quality.
CareOregon is a nonprofit, mission-driven health plan focused on providing care to low-income Oregonians. They include Columbia Pacific CCO, Jackson Care Connect, Housecall Providers and their work as part of Health Share of Oregon and they are committed to quality. CareOregon is an equal opportunity employer.
Plan field audits based on risk, not routine clinic rotation.
Review reports critically and identify unsupported conclusions or weak evidence.
Escalate serious concerns with clear evidence and recommended next steps.
New Incentives - All Babies Are Equal Initiative is an evidence-based organization working to increase childhood vaccination rates through conditional cash transfers. They prioritize caregivers and infants, and their operations are guided by integrity, evidence, and continuous improvement.
Assist in preparation and review of policies, procedures, and agreements.
Research diverse topics; review internal operations and practices to ensure compliance.
Collaborate with teams across marketing, cybersecurity, IT, product, finance, and business functions.
Topstep is an engaging company that exists in both remote and hybrid environments. They foster a culture of collaboration by keeping cameras on during meetings and maintaining a robust Slack environment for communication.
Conduct proactive patient outreach initiatives to identify and address quality gaps.
Collect quality data using various methods of data sourcing-EMR, claims, provider outreach.
Communicate quality performances, barriers and improvement strategies both internally and with customers.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Support the implementation, monitoring, and reporting of quality improvement activities for a national maternal mental health hotline.
Track program performance, maintain compliance documentation, and contribute to quality reports for federal stakeholders.
Assist in coordinating meetings, developing training materials, and building a culture of continuous quality improvement across a remote team.
Postpartum Support International works to promote awareness, prevention, and treatment of mental health issues related to childbearing. The organization is composed of dedicated and passionate individuals and operates a federally funded national hotline.
Communicating with providers regarding claims, service issues and general network provider complaints.
Developing an adequate provider network in assigned geographical areas (currently Texas metroplex areas).
Building and maintaining relationships with contracted providers, including inquiries related to contract status, roster corrections and information accuracy.
Evry Health, a Globe Life company, aims to bring humanity to health insurance. They are a high-technology health plan expanding benefits and access, and feature a personalized, human approach. Globe Life has 16.8 million policies in force, with more than 3,000 corporate employees and 15,000 agents.