Conduct comprehensive MS-DRG and APR-DRG coding audits to validate assignments and identify overpayments.
Apply advanced ICD-10-CM/PCS coding guidelines and AHA Coding Clinic references to produce defensible audit findings.
Prepare clear audit reports and collaborate with stakeholders to maintain high quality and regulatory compliance.
We're a healthcare auditing company specializing in DRG and inpatient coding reviews, ensuring accuracy and reimbursement compliance for leading healthcare clients. We foster a collaborative, inclusive, and supportive remote culture with mentorship programs and ongoing professional development.
Manage accounts receivable, including analysis of aged AR and identification of root cause issues.
Investigate, resolve, and appeal insurance claim denials, contacting payer representatives as needed.
Collaborate with internal teams and care center staff to drive optimal revenue cycle performance.
Privia Health is a technology-driven physician enablement company that partners with medical groups and health systems to optimize practices and improve patient experiences. It is led by top industry talent and physician leadership with a focus on scalable operations and cloud-based technology.
Conduct detailed audits of medical claims, billing records, coding, and clinical documentation.
Partner with healthcare system clients to resolve billing discrepancies and improve reimbursement.
Serve as a subject matter expert on Medicare, Medicaid, and commercial payer billing requirements.
Jaan Health is an AI-based care management company serving healthcare providers with its Phamily platform to deliver proactive care. It is a fast-growing, early-stage company built on five principles: care, curiosity, clarity, co-creation, and craftsmanship.
Investigate claim denials, navigate evolving payer requirements, and ensure complex claims are prioritized and resolved accurately.
Partner with cross-functional teams to identify operational and denial trends, optimizing workflows and claim outcomes.
Act as the pod’s go-to expert for payer workflows, claim resolutions, and best practices, supporting new-hire onboarding and team performance.
Rula is a mental healthcare company dedicated to providing quality, evidence-based care and reducing stigma around mental health. It is a remote-first company with a focus on inclusion, employee well-being, and making mental healthcare work for everyone.
Perform line-by-line review of high-dollar facility itemized bills and claim forms to identify billing errors.
Apply coding and reimbursement expertise to validate accuracy and ensure claims are paid correctly.
Serve as a subject matter expert for complex billing issues and drive payment integrity improvements.
Oscar is a health insurance company built on a full-stack technology platform with a focus on serving members. Founded in 2012, it fosters a culture of transparency and collaboration, working to change health care.
Own Medicare billing, provider enrollment, and compliance for the group.
Review and release every claim before it goes to Medicare, checking codes and documentation.
Support physicians and their offices with billing questions, onboarding, and payment reports.
Integrated Complex Care Associates (ICC) is a California physician group that serves patients with complex health needs, led by each patient's own primary physician. The team is building its billing function from the ground up, so this role is the first full-time hire and offers a hands-on, independent culture.
Coordinate hospice room and board invoice processing, validate billing information, and ensure accurate reimbursement and timely payments.
Collaborate with healthcare facilities and cross-functional teams to resolve billing discrepancies and maintain reliable financial records.
Track outstanding items, analyze reporting data, and identify opportunities to improve workflows in a remote healthcare setting.
Jobgether is a platform that uses AI-powered matching to connect candidates with job opportunities. The company focuses on fair and objective application review and partners with hiring companies to streamline recruitment.
Partner with Clinical, Claims, and SIU teams to review claims for billing and coding issues.
Leverage internal AI tools and predictive models to identify anomalous billing patterns and support prepayment audits.
Collaborate with Data Science and Engineering to validate AI-flagged claims and refine machine learning models.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep members healthier. It is a fast-growing, remote-first startup with a mission-driven, collaborative culture focused on improving healthcare.
Analyze hospital claims to identify discrepancies between expected and actual insurance reimbursements.
Investigate underpayments and payment variances by examining coding errors, billing discrepancies, and payer policies.
Collaborate with insurance carriers and internal stakeholders to resolve billing issues and improve revenue recovery outcomes.
This partner company specializes in healthcare revenue integrity, helping hospitals recover appropriate reimbursement for services. The team fosters a collaborative, inclusive culture focused on continuous improvement and professional development.
Audit medical claims for government payers, applying medical review guidelines and documenting findings.
Generate letters articulating audit findings and support them during the appeals process.
Collaborate with the audit team and clients to improve medical policies and minimize appeals.
Machinify is a healthcare intelligence company providing AI-powered payment solutions for health plans. It serves over 85 health plans and more than 270 million lives, with a culture focused on innovation and reducing healthcare costs.
Preparing billing and registration worksheets while collecting and verifying demographic information.
Contacting insurance companies as needed and submitting daily and monthly statistics.
Providing administrative support to physicians, the Medical Director, and the Corporate Office.
Pediatrix Medical Group is a physician-led provider of highly specialized health care for women, babies and children. It is one of the nation's largest multi-specialty medical groups, with a team-oriented culture focused on clinical excellence.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Resolve disputed claims by gathering, verifying, and providing additional information.
Resolve discrepancies by examining and evaluating data and selecting corrective steps.
Maintain work operations by following policies and procedures and reporting compliance issues.
Surgery Partners is a healthcare services organization providing surgical care. It is committed to equal employment opportunity and workforce diversity.
Process and transmit electronic and paper claims to insurance companies, patients, and other responsible parties.
Follow up on unpaid claims, review rejections, and resolve payment questions with insurance providers.
Verify insurance benefits, analyze charges and payments, and support coordination of benefits for patient accounts.
Munson Healthcare is northern Michigan's largest healthcare system, operating eight award-winning community hospitals across 29 counties. The organization values excellence, teamness, positivity, and creativity, and is committed to creating exceptional experiences for patients and staff.
Conduct clinical reviews of medical records during fraud investigations and program integrity initiatives.
Apply Medicare and Medicaid guidelines to determine appropriateness of payment coverage.
Compile investigative summary reports and provide training on medical terminology and policy interpretation.
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk. They are an equal opportunity employer committed to diversity and inclusion, maintaining a drug-free workplace.
Conduct clinical and billing reviews of claims, itemized bills, and UB-04 forms to ensure accuracy.
Perform utilization reviews to assess medical necessity and validate charges against policies.
Mentor reviewers, meet productivity targets, and maintain active RN licensure with CEUs.
Our partner is a healthcare services company that conducts medical claims and utilization reviews to ensure accurate billing and appropriate care. They offer a collaborative, quality-focused remote environment with opportunities for professional development.
Review clinical documentation and ensure accurate charge entry in the billing system.
Submit insurance claims, monitor status, and resolve denials to maintain a clean billing cycle.
Support families with billing questions and assist with accounts receivable monitoring.
InStride Health delivers specialty anxiety and OCD care for kids, teens, young adults, and families through evidence-based clinical care and technology. The company is a mission-driven startup focused on expanding access to insurance-based care, with a collaborative culture grounded in values like heart, humility, and community.
Ensures accuracy, completeness, and compliance of medical coding and clinical documentation.
Reviews patient records and coded data to identify discrepancies and support proper reimbursement.
Conducts chart reviews and audits, provides coding education, and prepares audit reports.
Emory Healthcare is a comprehensive healthcare system based in Atlanta, GA, providing a range of medical services. The organization fosters a supportive culture with mentorship, leadership programs, and comprehensive benefits.
Process and submit claims to health plans accurately and on time, maintaining momentum through the billing cycle.
Investigate denied and rejected claims, identify root causes, correct, and resubmit; flag recurring patterns to fix issues at the source.
Monitor claim status, follow up on reimbursement, support reporting and month-end close, and partner with finance, product, and engineering teams.
Foodsmart is a leading Foodcare platform that delivers personalized nutrition care and food benefits to improve health outcomes while lowering healthcare costs. With over 3 million members and backed by a $200 million investment, the company is mission-driven to make nutritious food accessible and affordable for everyone.
Process billing data entry with 10-key skills and compare data with source documents.
Research and update billing demographic data to ensure prompt payment from insurance.
Communicate via phone with clients and patients to resolve billing defects and verify insurance information.
Labcorp is a global leader in laboratory services, providing diagnostic testing and drug development solutions that help healthcare providers, researchers, and patients make informed decisions. With nearly 70,000 employees serving clients in more than 100 countries, Labcorp fosters a collaborative culture focused on improving health and improving lives.