Review clinical documentation and treatment trajectory to ensure care meets medical necessity standards.
Synthesize clinical documentation, medical record information, and outcomes data to make recommendations on next steps in care.
Partner cross-functionally to support high-quality, clinically appropriate care across the network.
Rula is dedicated to treating the whole person and aims to create a world where mental health is no longer stigmatized. They are a remote-first company committed to providing quality, evidence-based, and compassionate care, empowering individuals to take charge of their mental health.
Deal directly with internal and external customers via telephone and electronic channels.
Track sample collection kits and answer questions regarding test status.
Assist CLS/MLS Data Reviewers in answering questions from clinics and customer support.
Natera is a global leader in cell-free DNA testing, dedicated to oncology, women’s health, and organ health. Natera's team consists of statisticians, geneticists, doctors, laboratory scientists, business professionals, and software engineers from world-class institutions.
Review medical records to identify clinical information and flag missing documentation.
Coordinate medical record requests and track case pipelines to ensure timely receipt.
Support provider and patient outreach and contribute to operational improvement projects.
Natera is a global leader in cell-free DNA testing, dedicated to oncology, women's health, and organ health. The team consists of highly dedicated professionals from world-class institutions who care deeply for their work and each other.
Supports Curana Health’s mission, values, and commitment to excellent service.
Protects patient information by following all Corporate Compliance and HIPAA guidelines.
Organizes and maintains accurate files, logs, and reports for the medical records department.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. Founded in 2021, they have grown to serve 200,000+ seniors in 1,500+ communities across 32 states with a team of more than 1,000 clinicians and professionals.
Review assigned TEFCA directory entries against authoritative corroboration sources and apply the approved review methodology.
Research, validate, and reconcile healthcare directory data across multiple reference sources, documenting findings in Jira.
Classify entries using a four-tier disposition taxonomy and escalate exception-path entries to the Lead Analyst.
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) that provides expert program management, technology, and consulting solutions to government and private sector clients. As a small business, they emphasize integrity, collaboration, and excellence in their tailored solutions.
Execute day-to-day provider enrollment, credentialing, and licensing tasks under guidance.
Input, maintain, and update provider data across databases and internal systems.
Review and process enrollment applications, supporting documentation, and status updates.
Allara is a women’s health provider that specializes in expert, longitudinal care that supports women through every life stage. Allara makes expert healthcare accessible by connecting patients with multidisciplinary care teams and is trusted by over 60,000 women nationwide.
Serve as the primary operational liaison to NMDP and other registry partners across clinical and commercial programs.
Design, implement, and continuously improve scalable donor cell acquisition processes supporting the commercial launch of Orca-T and Orca Bio's clinical programs, incorporating transplant center feedback and industry best practices.
Assess capacity constraints in apheresis and patient operations infrastructure across the transplant center and registry network and proactively engage partners on solutions.
Orca Bio is a late-stage biotechnology company redefining the transplant process by developing next-generation cell therapies. With our purified, high-precision investigational cell therapies we hope to not only replace patients' blood and immune systems with healthy ones, but also restore their lives.
Support payer audits and medical record reviews, ensuring timely submission of documentation.
Manage medical review requests and appeals associated with CMS contractors and regulatory agencies.
Review clinical documentation using audit checklists and partner with teams to gather required records.
VitalCaring is a provider of home health and hospice services founded in 2021. They are a growing company focused on quality and compliance, with a mission to deliver exceptional patient care.
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.
Conduct clinical reviews of medical records to determine medical necessity and payer compliance.
Evaluate denial cases including appeals, audits, and no-authorization determinations.
Develop evidence-based clinical rationales aligned with payer and regulatory guidelines.
This partner company provides clinical review and healthcare reimbursement support services. The team is remote and operates in a fast-paced, performance-driven environment.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Apply payer-specific guidelines and internal policies to support clear, defensible clinical narratives.
Meet assigned turnaround times and document findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable reimbursement solutions and clinical expertise, leveraging technology and analytics. The company builds long-term careers by investing in professional development and personal growth, fostering a culture of accountability and success.
Reviews patient data for Phase I-IV clinical research and non-interventional studies to ensure compliance with protocols and regulatory requirements.
Communicates and escalates serious issues to the project team and develops action plans as needed.
Maintains working knowledge of ICH/GCP guidelines and company SOPs, documenting activities per project requirements.
Syneos Health is a leading fully-integrated life sciences services organization built to accelerate customer success. We are a global company with over 29,000 employees, dedicated to developing our people and building an inclusive culture.
Answer calls and resolve questions, routing to appropriate departments.
Complete documentation in EMR and marketing systems, including initial prescreening.
Schedule new and returning patients and complete follow-up duties.
Pyramid Healthcare provides addiction treatment, mental health recovery, and eating disorder treatment. They focus on client-centered care and offer supportive environments that help patients overcome life’s challenges.
Works with field staff and Manager, Clinical Services (MCS) to appropriately schedule clinicians for cases in assigned areas of responsibility.
Communicates appropriately regarding changes in schedule or service delivery.
Demonstrates the ability to be efficient and productive by organizing job duties and responsibilities.
CommonSpirit Health at Home is a full-service health care organization that believes the best place for someone to get better is in their own home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and the health of the communities we serve.
Oversee and/or perform an accurate medical record review for all RISK.
Conduct training related to ,RISK, platform usage, update any training materials, and function as RISK SME.
Manage RISK coding projects when needed- including project status and completing chart reviews for coding projects as needed.
Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. They are trusted by 80+ customer organizations nationwide and work to advance care quality, strengthen documentation integrity, and sustain operational readiness.
Perform ongoing clinical data review to ensure data quality, consistency, and completeness.
Identify discrepancies and raise/resolve queries in EDC systems.
Review patient data including eligibility, medical history, treatment, safety data, and outcomes.
Syneos Health is a leading fully-integrated life sciences services organization built to accelerate customer success. They partner with innovators at every point across the drug development and commercialization continuum, helping them navigate complexity and anticipate change.
Processes applications for credentialing and privileging, both initial and reappointment, adhering to policies and procedures related to legal, state, OHSU, DNV, TJC, and NCQA guidelines.
Investigates and validates discrepancies and adverse information from applications and primary source verifications, communicating with credentialing contacts ensuring timely and accurate completion.
Maintains practitioner credential files, containing confidential peer review information, and updates credentialing databases with detailed documentation during all steps, from receipt of application to processing completion.
OHSU is Oregon's only public academic health center, focused on patient care, research, and training the next generation of healthcare professionals. As Portland's largest employer, OHSU provides opportunities for learning and advancement within its system of hospitals and clinics.
Transfer data from vendor websites and internal Verse systems to finance spreadsheets
Track profitability of new customers
Great communication, ability to learn new things and take feedback when provided by leaders
Verse Medical is building the modern software infrastructure to make it happen. The platform connects the dots between providers, payors, and patients, ensuring people get the high-quality care they need, reliably and right where they live. We're growing fast and looking for people who are driven by this mission to join us!
Enrolls providers new to Privia with all commercial health plans specific to the market.
Updates and maintains provider enrollment status in credentialing system, CredentialStream.
Performs follow up with health plans according to designated timeline, until Provider is PAR.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Privia Health consists of scalable cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Review patient EMR records to determine medical eligibility for Aviary Health.
Monitor and respond to real-time clinical questions from Care Team members.
Communicate patient eligibility to enrollment team through documentation within platforms.
Aviary Health is redesigning heart health from the ground up so that everyone can live fuller lives. Their team consists of mission-driven clinicians, engineers, and professionals attacking a problem using evidence-based research and guidelines for cardiovascular rehabilitation.