Interpret and assess payment policy and medical coding guidelines to maintain and develop the medical policy library.
Conduct thorough research and multi-faceted analytics to identify opportunities and ensure policy accuracy.
Collaborate with client-facing teams and internal stakeholders to educate on policy updates and drive quality.
Cotiviti is a healthcare analytics company focused on payment accuracy and quality improvement solutions. The company maintains a collaborative culture and values innovation, though its size is not specified.
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.
Analyze and process complex medical claims in accordance with program policies and procedures.
Apply critical thinking to adjudicate claims and resolve issues through collaboration with internal departments.
Maintain confidentiality of patient records and ensure thorough record-keeping in compliance with HIPAA regulations.
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business providing expert program management, technology, and consulting solutions. As a small business, they emphasize integrity, collaboration, and excellence in serving government and private sector clients.
Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools.
Partner with data science teams to validate AI outputs and improve model performance.
Serve as a coding subject matter expert to support audit concept development and optimization.
Cotiviti is a healthcare analytics company specializing in payment integrity and data-driven solutions. The company fosters a collaborative culture and emphasizes innovation in healthcare audit and analytics.
Manage high-value medical claims, denials, and appeals to ensure accurate and timely reimbursement.
Analyze unpaid/underpaid claims, investigate billing errors, and communicate with insurance payors via portals, phone, and email.
Maintain detailed documentation, process updates, and collaborate with internal teams to resolve complex accounts receivable issues.
Our partner operates within the healthcare revenue cycle, ensuring accurate reimbursement for medical services. They are a collaborative team focused on improving financial outcomes and maintaining compliance with healthcare regulations.
Manage and resolve claims rejections and denials, escalating trends as identified.
Verify patient eligibility and benefits, and coordinate with insurance payers.
Maintain compliance with HIPAA regulations and meet productivity standards.
Workit Health is an industry-leading provider of on-demand, evidence-based telemedicine care for addiction. They are a growing company with a dedicated team passionate about making judgment-free care accessible.
Support quality assurance and audit planning for the WTC Health Program
Analyze claims data to identify trends and recommend improvements
Maintain health plan codebook and ensure accurate medical coding standards
Advanced Technologies & Laboratories International, Inc. (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. The company offers a competitive total compensation package and invests in professional growth through tuition reimbursement and certification programs.
Develop and maintain system pricing for health care claims.
Analyze contract financial performance and coordinate internal/external audits.
Provide routine and ad hoc reporting to support business decisions.
HCSC is a health insurance company dedicated to expanding access to high-quality, cost-effective health care. With over 80 years of experience, they foster a collaborative and inclusive culture that values employee development and diversity.
Perform daily audits on client data for completeness and accuracy of coding using clinical knowledge.
Respond to provider appeals and meet client turnaround time and KPI goals.
Utilize coding validation training to become familiar with claims payment policies and regulations.
Cotiviti is a healthcare analytics company that uses data-driven solutions to improve payment accuracy and quality in healthcare. The company offers a competitive benefits package and fosters a collaborative, fast-paced work environment.
Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Apply CMS guidance, coding guidelines, and industry standards during claim review, including hospital bill audits and itemized bill reviews.
Prepare appeal responses using applicable coding guidance and maintain required certifications and continuing education.
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. They are a dynamic growing organization promoting a collaborative and innovative work environment.
Review and validate medical codes for accuracy and compliance with ICD-10, CPT, HCPCS, and other coding systems.
Provide expert coding guidance and support to clinicians and departments, serving as a resource for complex coding questions.
Conduct coding audits, generate productivity reports, and collaborate with IT and billing teams to resolve system issues.
Mission Healthcare is a home health and hospice company serving seven states, the largest of its kind in the western United States. They emphasize a culture of compassion, accountability, respect, excellence, and service (CARES) and are committed to diversity and inclusion.
Abstracts and codes physician professional services using CPT and ICD-9 codes.
Provides documentation feedback to physicians and trains staff on billing and coding.
Resolves pre-accounts receivable edits and ensures charge capture through reconciliations.
Northwestern Medicine is a healthcare leader with a patient-first approach. They offer competitive benefits like tuition reimbursement, loan forgiveness, 401(k) matching, and lifecycle benefits, supporting a diverse team dedicated to better healthcare.
Monitor denial volumes, aging, and identify trends to improve coding quality processes.
Develop and implement new programs, processes, and standards to streamline workflows and enhance efficiency.
Collaborate with leadership to support annual and long-term strategy planning and execute departmental goals.
UnityPoint Health is a healthcare system dedicated to providing quality care and has been recognized as a Top 150 Place to Work in Healthcare. They foster a culture of belonging and offer support and development opportunities for their team members.
Serve as the primary client contact and trusted advisor, managing relationships and ensuring client success with Cotiviti's PPM/CV products.
Coordinate cross-functional teams to execute client strategic plans, monitor program performance, and identify growth opportunities.
Manage operational implementation of client payment policy decisions and provide training to optimize program performance.
Cotiviti is a healthcare analytics company specializing in payment integrity and cost verification solutions. The company fosters a collaborative culture and values client success, with a focus on innovation and data-driven insights.
Oversee the processing of initial payer applications to ensure compliance with accreditation standards and regulations.
Maintain and manage payer credentialing databases with accuracy and audit readiness.
Supervise payer credentialing staff by coordinating workloads, providing training, and monitoring performance.
Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. They serve facilities across the United States, offering multispecialty physician services, telemedicine, and remote patient monitoring.
Conducts baseline, routine, and focused audits comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes.
Researches, interprets, and communicates federal and state laws and guidelines pertaining to CMS and Medicare.
Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.
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 focuses on scalable operations and cloud-based technology to reduce healthcare costs.
Review and abstract professional medical records to ensure accurate code assignment.
Assign ICD-10-CM, CPT, HCPCS, and applicable modifiers following national and payer-specific guidelines.
Maintain coding quality metrics and participate in coding audits.
We reimagine how people access care by bringing it directly into their homes. We have supported over 2 million patients across 22 states, completed over 130,000 in-home visits, and raised over $125M from top investors.
Coder III demonstrates proficiency in coding high acuity inpatient accounts and/or technical outpatient accounts.
Utilizes ICD-10-CM, PCS, HCPCS, CPT, and other coding references for accurate coding.
Supports Revenue Cycle goals for timely billing.
Cooper University Health Care is committed to providing extraordinary health care. We offer competitive rates, comprehensive benefits, and opportunities for career growth.
Research and resolve insurance claims to maximize cash collections and minimize denials.
Maintain worklists and assignments based on performance targets and quality scores.
Interface with payers and internal partners to conduct follow-up and escalate items promptly.
USACS is a clinician-centric provider of hospital-based emergency and inpatient medicine, serving 11 million patients annually in 400+ programs across 27 states. They are a large practice prioritizing personal and professional satisfaction with a culture of robust support.
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.