Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Machinify is a healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They deploy a configurable, AI-powered platform and best-in-class expertise, serving over 85 health plans representing more than 270 million lives.
Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.
Conduct advanced, strategic analysis of paid claims, uncovering critical audit insights that drive process improvements and enhance organizational knowledge.
Make determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance.
Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. They are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.
Review and audit medical claims for accuracy and compliance.
Listen to customer service phone calls for accuracy and professionalism.
Prepare reports on audit findings and recommendations for process enhancements.
Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They focus on cost containment strategies with innovative solutions. The posting does not specify the number of employees or further details about the culture.
Perform comprehensive medical record and claims review to make payment determinations for Medicare PART A.
Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides federal agency leaders with tools to elevate their workforce's potential through meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.
Review patient records to ensure documentation aligns with medical, legal, regulatory, and insurance standards.\n- Abstract appropriate supporting documentation into abstraction tool.\n- Collaborate with healthcare providers or internal staff to clarify unclear or incomplete documentation.
Capital Blue Cross promises to go the extra mile for its team and community, and its employees consistently vote it one of the “Best Places to Work in PA”. The company offers a flexible environment where health and wellbeing are prioritized and invests in training and continuing education.
Conduct audits comparing medical record documentation to reported codes.
Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.
Provide feedback, education, training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision and coding principles.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. Their platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Leads analysis of clinical and technical denials, using analytics tools to identify patterns and trends.
Performs root cause analysis on denied accounts and uses process improvement expertise to guide subject matter experts.
Oversees denial prevention committee reports and summaries, maintaining client relationships to drive best practice implementations.
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. They believe their people are the most important part of who they are and empower them to challenge the status quo.
Perform coding audits and reviews on a variety of professional fee record types.
Perform necessary research in order to provide the client with supportive regulatory and coding guideline documentation.
Assist in the design and presentation of educational seminars to clients and staff
UASI is an award-winning company with over 40 years of experience, offering consulting services. We have enduring partnerships with our valued clients, stability, and long-term success of our dedicated team.
Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types
Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans
Perform necessary research to provide to the client to support findings.
UASI is recognized as a Top Workplace. With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we’ve built and the long-term success of our dedicated team.
Review and analyze claims, member, and group data.
Establish the correct order of liability for clients’ members.
Input accurate claim recovery information into software tools.
Cotiviti delivers comprehensive payment accuracy services that help organizations improve their healthcare outcomes. Team members enjoy a competitive benefits package and are encouraged to embody Cotiviti's core values.
Establish and monitor performance metrics to measure the reliability and latency of payer data feeds.
Serve as the primary point of escalation for high-priority payer data issues, coordinating with various teams.
Oversee the documentation and submission processes for clinical data extracts to ensure audit readiness.
Aledade empowers independent primary care practices to deliver better patient care and thrive in value-based care. As the largest network of independent primary care in the country, they focus on creating value-based contracts, strengthening care continuity, and aligning incentives to ensure physicians are paid for keeping patients healthy.
Design, execute, and ensure operational excellence of risk adjustment coding and clinical documentation programs.
Create scalable, physician-centric educational programs for accurate and complete diagnosis documentation.
Lead a multidisciplinary team of coders, auditors, and analysts to ensure operational excellence and talent development.
Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. They're the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
Conducts audits of clinical documentation reviews to ensure compliance and regulatory requirements.
Develop and deliver training sessions based on audit findings to support CDI team competency.
Oversee the accuracy, specificity, and completeness of clinical documentation.
Adventist HealthCare is a faith-based, not-for-profit organization dedicated to improving the health and well-being of people and communities. They employ over 6,000 professionals and are one of the longest serving healthcare systems in the Washington, D.C., area.
Responsible for coding procedures and entering charges to comply with regulations and internal policies.
Coordinate with Practice Coordinator and Revenue Integrity to assure all necessary documentation is present.
Participate in audits to evaluate if all selected codes are accurate and develop methodologies to improved coding issues.
Northside Hospital is an award-winning and state-of-the-art hospital that is continually growing. They are expanding the quality and reach of their care to patients and communities which creates more opportunity for healthcare professionals in Atlanta and beyond.
Own end-to-end financial modeling for CMS LEAD and other APMs.
Work directly with CMS VRDC data environments to extract, structure, and analyze Medicare claims and enrollment data.
Establish independent validation standards and ensure consistent adherence to these standards across the enterprise.
Arcadia transforms complex, diverse data into a unified foundation for health, helping organizations deliver better care, boost revenue, and lower costs. They are a team of fiercely driven individuals committed to making healthcare more sustainable.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards with your expertise and training.
Review patient medical record information via population health tools to identify, assess, monitor and review network coding opportunities.
Dignity Health Management Services Organization (Dignity Health MSO) aims to build a system-wide integrated physician-centric, full-service management service organization structure. They provide management and business services, leveraging economies of scale and leading efforts in developing Medicaid population health care management pathways.