Provide strategic leadership and operational oversight for CMS-mandated RADV audits across Medicare Advantage and Commercial lines of business.
Lead development of audit strategies, workflows, and performance objectives to support regulatory compliance and organizational goals.
Direct departmental operations including staff development, performance management, and cross-functional coordination to ensure successful execution of priorities.
Lead a high-performing team of QA Specialists at the intersection of clinical precision and operational excellence.
Drive coding accuracy, build robust SOPs, and ensure full audit readiness for internal and external partners.
Translate QA findings into actionable insights and mentor team members to elevate compliance standards.
Aledade PBC empowers independent primary care through value-based care. Founded in 2014, it is the largest network of independent primary care in the country with a remote-first, inclusive culture.
Drive operational excellence across provider risk adjustment, HCC coding, and value-based care programs while overseeing coding services delivered by domestic and global teams.
Serve as the primary strategic lead and escalation point for health plan and provider clients, maintaining accountability for service quality and client satisfaction.
Manage, mentor, and develop diverse coding teams across locations, ensuring coding activities follow organizational standards and regulatory requirements.
Our partner is a company that drives operational excellence in healthcare through risk adjustment, HCC coding, and value-based care programs. They are a senior leadership focused organization that manages coding services with diverse teams, emphasizing quality and compliance.
Conduct coding audits to ensure accuracy and compliance with ICD-10, CPT, and HCPCS guidelines.
Document findings with authoritative references and support corrective actions and education.
Stay current on payer rules and flag compliance risks to senior leadership.
Alteva RCM provides expert revenue cycle management and strategic solutions for healthcare providers. They foster a collaborative team culture committed to excellence, seeking passionate professionals to grow their careers.
Ensure coding accuracy and compliance for radiology, PET, and Nuclear Medicine services through audits and quality reviews.
Collaborate with coding leadership, revenue cycle teams, and vendors to improve reimbursement outcomes and operational efficiency.
Leverage advanced auditing skills and AI-assisted coding platforms to drive continuous improvement in coding quality.
SimonMed Imaging is a medical imaging company that provides radiology, PET, and Nuclear Medicine services. The company emphasizes coding accuracy, compliance, and revenue integrity, and fosters a collaborative culture with cross-functional teams.
Provide real-time documentation support to healthcare providers before and after patient encounters.
Evaluate chart review performance and assist physicians in improving coding and documentation best practices.
Ensure compliance with federal and state laws related to coding and documentation guidelines for risk adjustment.
Interwell Health is a kidney care management company that partners with physicians to reimagine healthcare. They are mission-driven and value diversity, equity, and inclusion.
Strategically coordinate and optimize the flow of coded medical record information to ensure accurate billing and reimbursement.
Review surgical coding submissions and manage denials to maximize revenue capture and compliance.
Design and deliver impactful educational programs that elevate documentation practices and coding quality.
Henry Ford Health is an academic health system providing comprehensive care across Michigan and beyond. With 12 hospitals and hundreds of ambulatory locations, the organization is a large, purpose-driven team committed to innovation and community impact.
Manage day-to-day operations for the outpatient clinical documentation improvement program across multiple facilities.
Liaise with physicians and leadership on coding rules, risk adjustment, and reimbursement guidelines.
Ensure compliant and accurate medical record documentation while facilitating standardization.
Henry Ford Health is an academic health system providing comprehensive care across Michigan. With 12 hospitals and hundreds of clinics, it is a large organization focused on collaboration and innovation.
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.
Perform comprehensive chart reviews to ensure documentation supports accurate HCC reporting.
Identify claims correction opportunities and submit them for processing.
Provide provider education and analyze coding trends for assigned medical groups.
Dignity Health Medical Foundation is a California nonprofit providing comprehensive health care services across the state. As part of Dignity Health, one of the largest U.S. health systems, it emphasizes purposeful work and staff growth.
Lead professional billing coding and clinical documentation integrity programs across a complex health system, ensuring coding accuracy and regulatory compliance.
Oversee team operations, including staffing, performance monitoring, audit education, and continuous process improvement.
Build strong relationships with executives, physicians, and coding professionals to drive quality and reimbursement integrity.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use technology to review applications and share top-fitting candidates with employers, fostering an inclusive and efficient hiring process.
Conduct prospective chart reviews to validate ICD-10-CM and CPT coding accuracy.
Provide clinical documentation improvement feedback to providers on documentation gaps.
Ensure compliance with risk adjustment and regulatory coding guidelines.
Thyme Care is a cancer care navigation company transforming the cancer care experience through value-based care. They are building a diverse, mission-driven team to reshape the future of healthcare.
Lead, coach, and develop a team of coders, ensuring daily accuracy, productivity, and compliance.
Serve as the primary escalation point for complex coding issues, partnering with billing and clinical teams.
Monitor KPIs, manage audits, and drive revenue integrity through cross-functional collaboration.
Alteva RCM helps healthcare providers thrive through expert revenue cycle management, strategic insight, and innovative solutions. They are a dedicated, collaborative team committed to excellence, always seeking passionate professionals to grow their careers and make a meaningful impact.
Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient and outpatient claims.
Conduct in-depth claims analysis using coding principles and electronic health information systems to ensure assigned codes are supported by documentation.
Meet quality and production standards and ensure compliance with quality management systems and ISO requirements.
Empower AI provides AI for government, helping federal agencies transform their workforce. With three decades of experience in Health, Defense, and Civilian missions, it is headquartered in Reston, VA and recognized as a 2024 Military Friendly Employer.