Process assigned claims based on client-specified guidelines.
Meet productivity targets and procedural accuracy standards.
Mentor junior team members and collaborate on special projects.
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. With a global presence and over 4000 employees, they are dedicated to simplicity, honesty, and leadership.
Focuses on ensuring accuracy, compliance, and integrity of medical coding across healthcare records.
Conducts detailed audits, reviews clinical documentation, and identifies discrepancies impacting billing and compliance.
Collaborates with clinicians, revenue cycle teams, and leadership to improve documentation quality and coding consistency.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They process applications and share shortlists with employers, focusing on objective and fair review.
Serve as an expert in coding guidelines and perform audits to ensure compliance.
Develop and deliver role-specific training and educational materials for coding staff.
Analyze billing/coding behavior and recommend improvements.
UW Medicine is Washington’s only health system with a top-rated medical school and an internationally recognized research center. Nearly 29,000 healthcare professionals, researchers, and educators work within its family of organizations.
Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG 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 provides an AI-powered clinical intelligence platform that streamlines access to quality care by improving payer-provider collaboration and cost containment. The company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 and 2024.
Conduct training and education on risk adjustment documentation and coding guidelines for providers.
Perform comprehensive medical record chart audits to validate ICD-10-CM coding and HCC assignments.
Analyze claims data and audit error rates to identify trends and recapture opportunities for chronic conditions.
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, with scalable operations and cloud-based technology.
Investigate and resolve health plan denials for coding-related issues, including rejections, down codes, bundling, modifiers, and level of service.
Generate appeals based on dispute reasons and contract terms specific to payors, including online reconsiderations and following payer guidelines.
Maintain working knowledge of workflows, systems, and tools used in the department, adhering to production and quality standards.
Ventra is a leading business solutions provider for facility-based physicians, focusing on Revenue Cycle Management. The company partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver data-driven solutions.
Abstracts and codes physician professional services and diagnosis codes (inpatient admissions, outpatient procedures, diagnostic services).
Assigns appropriate CPT and ICD9 codes and completes coding and billing worksheets.
Trains physicians and other staff regarding documentation, billing and coding, and resolves pre-accounts receivable edits.
Northwestern Medicine is a healthcare organization dedicated to providing patient-first care and advancing better health. As a large healthcare system, it offers competitive benefits including tuition reimbursement, loan forgiveness, and 401(k) matching, fostering a supportive culture focused on employee well-being.
Support accurate risk adjustment coding by performing first-pass reviews of member medical records.
Maintain compliance with CMS risk adjustment diagnosis coding guidelines and HCC coding standards.
Collaborate with a remote team and contribute to team success through proactive communication and continuous learning.
BlueCross BlueShield of Tennessee is Tennessee's largest health benefit plan company, helping members since 1945. As a remote-first organization, it fosters a culture of innovation and collaboration with a focus on employee well-being.
Lead advanced coding education for providers and groups, including E/M and Medicare Preventive services.
Analyze coding performance indicators to identify training needs and improve accuracy.
Develop and refine coding presentations and materials reflecting latest industry standards.
Privia Health is a technology-driven, national physician enablement company that optimizes physician practices and improves patient experiences. The company is led by top industry talent and physician leadership, with scalable operations and cloud-based technology.
Auditing claims for medically appropriate services in inpatient and outpatient settings using medical review guidelines.
Documenting findings with reference to appropriate policies and rules.
Generating letters articulating audit findings.
Machinify is a healthcare intelligence company delivering value and efficiency to health plan clients across the US. Deployed by over 85 health plans representing over 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare cost reduction.
Provide medical coding, system configuration, and administrative support for medical policy functions.
Perform coding analyses and utilization reporting to recommend updates to medical policies and system configuration.
Participate in cross-functional meetings to align with enterprise strategic priorities and support team operations.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. We prioritize member well-being over profits, with a focus on sustainability and innovation.
Responsible for coding procedures and entering charges to comply with federal/state regulations.
Coordinate with Practice Coordinator and Revenue Integrity to ensure documentation supports procedure codes.
Participate in audits to evaluate code accuracy and develop methodologies to improve coding issues.
Northside Hospital is an award-winning, state-of-the-art healthcare provider in Atlanta, Georgia. It is continually growing, offering opportunities for healthcare professionals in a supportive environment.
Analyze benefit plan documents to build benefit categories and adjudication rules for claims processing.
Review member accumulators and assist in loading benefit logic to member and group records.
Manage daily configuration inventory queues and support cross-functional teams during implementations and renewals.
Gravie creates health benefits that actually benefit small and midsize businesses and their employees. They are well capitalized, have top-tier investors, and a diverse, non-hierarchical, merit-driven culture that values authenticity and high performance.
Review medical records and clinical documentation to ensure accurate, compliant coding per CMS, federal, state, and payer policies.
Conduct routine and focused coding audits, collaborate with clinical leadership and revenue cycle teams, and provide actionable recommendations.
Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, interpreting state-specific billing requirements.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual and in-home medical, behavioral, and social care, and are a remote-first, high-growth environment.
Review, evaluate, appeal, and follow up on denied and underpaid claims using proprietary software.
Use payment documentation and contract information to ensure correct reimbursement.
Research and submit complex underpayment appeals to payers for timely claim resolution.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations using proprietary automation. The company has been recognized as a top workplace and among the fastest-growing private companies in the US for eleven years.
Provide clinical leadership and subject-matter expertise to support analysis and configuration of medical policy content within claims processing systems.
Ensure accurate implementation of medical policies, review criteria, and authorization requirements while maintaining system infrastructure integrity.
Serve as an expert resource for medical policy configuration and PGE coding, mentoring Coding Specialists and providing training to operational partners.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota. We are motivated by the well-being of our members, not profits, and we are committed to sustainability and innovation.
Manage the full lifecycle of edit and audit development, converting complex medical policy and coding regulations into actionable logic specifications.
Partner with PI Directors, internal auditors, and claims operations to ensure coding and billing appropriateness and regulatory compliance.
Use data queries to prove financial validity of coding hypotheses and author technical specification documents.
Devoted Health is an all-in-one healthcare company combining health insurance, clinical care, service, and technology to improve the health and well-being of older Americans. Founded in 2017, we've grown fast and now serve members across the United States, with a diverse and big-hearted team.
Assign accurate medical codes for inpatient/outpatient professional fee records with 95% or greater quality.
Work independently from a remote home office while meeting client productivity targets.
Maintain technical proficiency with VPN, multi-factor authentication, and office software.
UASI is a medical coding and auditing company with over 40 years of experience in the healthcare information management industry. They have been recognized as a Top Workplace for three consecutive years and emphasize professional growth and a supportive team culture.