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.
HealthEdge provides AI-powered operational infrastructure for health insurance companies. The company is experiencing strong market momentum and investing in its people to shape the future of healthcare technology.
Audit medical records to ensure documentation supports level of service and compliance with coverage determinations.
Develop and implement educational programs for coding and documentation improvement.
Orient and audit newly on-boarded providers and programs.
Southcoast Health is a not-for-profit health system providing comprehensive healthcare across Southeastern Massachusetts and Rhode Island. With multiple facilities, they have been voted 'Best Place to Work' for 7 years in a row.
Assess clinical documentation for compliance with AMA and CMS coding guidelines.
Provide education and guidance to providers, clinical staff, and coders on documentation standards.
Analyze audit data, report findings, and collaborate with leadership to improve coding practices.
UnityPoint Health is a healthcare system providing medical services across Iowa, Illinois, and Wisconsin. It is recognized as a top workplace, committed to team member support, development, and a culture of belonging.
Conduct routine and focused audits of medical coding to ensure compliance with CMS, payer, and organizational standards.
Develop and deliver education and feedback to coders and providers to improve documentation quality and coding accuracy.
Assist with internal and external audit preparation and response, including documentation requests and validation reviews.
Sprinter Health reimagines healthcare by delivering care directly to patients' homes using marketplace and last-mile technologies. They have supported over 2 million patients across 22 states, completed 130,000 in-home visits, and raised over $125M from investors like a16z and General Catalyst, with a team of clinicians, technologists, and operators.
Lead the strategy and execution of provider-facing risk adjustment initiatives.
Partner with teams like Network, Data Science, and external providers for cross-functional program delivery.
Analyze provider performance to identify opportunities and develop improvement plans.
Oscar is a health insurance company built around a full-stack technology platform focused on serving its members. Founded in 2012, Oscar is a sizable organization that fosters a culture of authenticity and belonging.
Assess clinical documentation for compliance with AMA and CMS coding guidelines.
Validate clinical documentation and evaluate accuracy and timeliness of the billing process.
Investigate and identify opportunities for improvement and provide education to providers and staff.
UnityPoint Health is a healthcare organization providing services across Iowa, Illinois, and Wisconsin. It is recognized as a top place to work in healthcare and fosters a culture of belonging, development, and total rewards.
Monitor operational activities for compliance with healthcare policies and established procedures
Support compliance reviews of billing, coding, claims, and documentation processes
Assist with internal audits, compliance assessments, and corrective action plans
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. The company's size and culture are not specified in the posting.
Lead the building and scaling of risk adjustment operations, including defining workflows and integrating into care delivery.
Drive broader clinical operations initiatives to improve care delivery workflows and cross-team coordination.
Translate strategic priorities into operational workplans, establish KPIs, and support performance visibility.
Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. The company is backed by leading venture firms and led by CEO Dr. Justin Bekelman, with a culture focused on transforming cancer care.
Conduct facility inpatient coding audits using MS-DRG and APR-DRG methodologies, providing evidence-based recommendations.
Identify coding quality and compliance opportunities while delivering coder education through the audit process.
Manage multiple cases concurrently, maintain accuracy, and uphold professional ethics and confidentiality.
Our partner provides healthcare organizations with high-quality, compliant coding practices through inpatient coding audits. They offer a collaborative, service-oriented environment focused on coding excellence and continuous professional development.
Perform accurate diagnostic and procedural coding for outpatient and/or inpatient medical records.
Assign diagnostic and procedure codes and modifiers to meet productivity, quality, and timeliness standards.
Serve as a subject matter expert and resource for other staff in coding and compliance.
Curana Health is a national leader in value-based care, offering senior living communities and skilled nursing facilities a range of solutions including on-site primary care and Medicare Advantage plans. Founded in 2021, the company has grown to serve over 200,000 seniors across 1500+ communities in 32 states, with a team of more than 1,000 clinicians and professionals ranked #147 on the Inc. 5000 list.
Manage a team delivering outsourced coding services to critical access hospitals and rural health clinics.
Ensure accurate and timely coding of medical records, compliance with ICD-10, CPT, and HCPCS guidelines.
Implement quality assurance audits, resolve coding discrepancies, and collaborate with providers and billing departments.
Tegria helps healthcare organizations improve care, technology, revenue, and operations, moving from patient-centered to human-centered. They have a diverse team of talented people who welcome challenge and change, fostering a culture of equity and inclusion.
Conduct clinical audits and risk assessments to identify compliance gaps.
Manage multiple client engagements and deliver accurate project results.
Build strong client relationships and present findings to leadership.
Kodiak Solutions transforms healthcare through technology-driven solutions, specializing in finance, unclaimed property, and risk management. Their innovative platform streamlines operations, allowing providers to focus on patient care.
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.
Apply certified coding expertise to healthcare coding activities while maintaining high accuracy and quality.
Review and interpret clinical and administrative documentation to support appropriate coding outcomes.
Follow established coding standards, policies, and regulatory requirements while protecting data confidentiality.
A partner company in the healthcare coding industry seeks a certified coding professional. The full-time remote role supports accurate and compliant coding operations in a structured environment.