Interpret and apply CMS, Medicare, Medicaid, and AMA policies to define claims editing logic.
Analyze claims and edit performance data to confirm accuracy and prioritize enhancements.
Monitor regulatory updates and coding changes to keep edits current and compliant.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. They use an AI-powered platform with expertise across the payment continuum, serving over 85 health plans and 270 million lives.
Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
Performs final reconciliation on clinic/provider visits, resolving documentation issues.
Reviews, abstracts, and codes multiple services and complex cases, assigning classifications.
Researches/resolves high volume accounts/claims and educates staff on guidelines.
University of Utah Health is a patient-focused organization with a mission to enhance the health and well-being of people through patient care, research, and education. They have five hospitals and eleven clinics and are known as a Level 1 Trauma Center, nationally ranked for academic research and patient experience.
The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system.
You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations.
Independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries where their corporate headquarters are in Dublin, Ireland.
Responsible for coding procedures and entering charges to comply with regulations and internal policies.
Coordinate with Practice Coordinator and Revenue Integrity to assure necessary documentation is present.
Participates in audits to evaluate code accuracy and develops methodologies to improve coding issues.
Northside Hospital is an award-winning and state-of-the-art healthcare provider that is continually growing. By constantly expanding the quality and reach of our care we hope to create even more opportunity for the best healthcare professionals in Atlanta and beyond.