Audit skilled nursing facility (SNF) medical claims for medically appropriate services using applicable guidelines and policies.
Document findings, generate audit letters, and support audit findings during the appeals process.
Work collaboratively with the audit team, clients, and contractors to improve medical policies and audit workflows.
Machinify is a healthcare intelligence company with expertise across the payment continuum, delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company combines an AI-powered platform with best-in-class expertise to drive down healthcare costs.
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.
Perform complex concurrent and retrospective audits of inpatient and outpatient medical records to validate coded data.
Analyze findings, identify root causes, and prepare summary reports for clients.
Develop and deliver educational content to clients on audit findings and coding compliance.
CorroHealth helps clients exceed their financial health goals through revenue cycle solutions and clinical expertise. The company prioritizes automation and scalability while investing in professional development and long-term careers.
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.
Conduct routine and targeted coding audits for internal and outsourced vendors across ASC, hospital outpatient, and professional fee services.
Review ICD-10, CPT, HCPCS, and payer policies to ensure coding accuracy, compliance, and documentation support.
Prepare audit reports, identify trends, provide coder education, and support performance improvement initiatives.
Surgery Partners is a healthcare services company operating ambulatory surgery centers and related facilities across the United States. With more than 58 facilities, the company prioritizes compliance, quality, and a diverse, inclusive workplace.
Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance.
Review up to 25 diagnoses and procedures per record, classify errors with references.
Deliver facility audit reports and lead training sessions for coding staff and clinicians.
Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach.
Review inpatient medical records to validate DRG coding accuracy.
Apply clinical judgment to identify discrepancies, coding errors, and overpayments.
Document evidence-based audit findings and meet quality standards.
The company specializes in healthcare claims auditing and analytics, improving accuracy and consistency in payments. It is a collaborative, fully remote environment that values precision, teamwork, and continuous improvement.
Conduct independent coding audits of inpatient, outpatient, and professional fee services across multiple specialties.
Analyze sampled medical records to identify and substantiate coding, documentation, and compliance errors.
Provide targeted education and train-the-trainer sessions to strengthen coding practices.
This company provides medical coding auditing and validation services for Veterans Affairs medical centers, supporting healthcare data quality and compliance. It operates in a mission-driven environment focused on improving coding accuracy for veteran-serving facilities.
Perform medical reviews and utilization management to determine medical necessity for services and appeals.
Evaluate medical records and document decisions using clinical guidelines and protocol sets.
Educate members, providers, and staff on coverage determinations, medical terminology, and coding procedures.
Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. As part of BlueCross BlueShield of South Carolina, we've served clients for 70+ years and offer training and tuition assistance.
Perform coding audits on professional fee medical records across multiple specialties.
Provide individualized feedback and education to coders and auditors for quality improvement.
Work remotely with a dedicated support team and enjoy competitive benefits and career growth.
UASI is a health information management consulting firm specializing in medical coding auditing and education. They offer a dynamic work environment with opportunities for career growth and top pay.
Audit medical summaries, timelines and record classifications against source records.
Write clinical review guidelines and gold-standard examples for research and engineering teams.
Flag clinically significant omissions, causation issues and prior-history findings.
Brighterway builds AI-native claims software and administration for casualty claims, starting with workers' compensation medical-legal review. The team is small, technical, and close to customers, with everyone shipping and talking directly to users.
Conduct audits of medical records for compliance with federal coding regulations and guidelines.
Provide education and training to providers on CPT, ICD-10, and HCPCS codes.
Act as an internal expert to ensure coding compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company collaborating with medical groups, health plans, and health systems. It aims to optimize physician practices and improve patient experiences through cloud-based technology and scalable operations.
Conduct targeted risk-based audits of high-risk diagnoses and HCCs to ensure clinical documentation supports reported diagnoses.
Deliver peer-level education and feedback to providers to improve documentation accuracy, specificity, and defensibility.
Collaborate with coding, compliance, and clinical leadership to reduce documentation risks and enhance audit readiness.
WellBe Senior Medical provides senior-focused healthcare services with an emphasis on risk adjustment and documentation integrity. The company fosters a remote, collaborative work environment and values compliance, education, and high-quality patient care.
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.
Audit inpatient medical records to validate ICD-10-CM/PCS coding, DRG assignments, and compliance.
Identify documentation gaps and develop compliant physician queries while collaborating with physicians.
Maintain productivity of at least three chart reviews per hour and complete accurate audit workpapers.
The hiring company provides clinical documentation improvement consulting services to healthcare organizations, focusing on accurate coding, compliance, and reimbursement. It fosters a collaborative, people-first environment and has been recognized as a Great Place to Work for three consecutive years.
Perform concurrent medical record reviews on nursing units to clarify patient documentation.
Prompt physicians to resolve missing, unclear, or conflicting documentation for appropriate reimbursement.
Provide education to patient care providers on clinical documentation standards and coding requirements.
Virginia Mason Franciscan Health provides a full spectrum of health care services across the Puget Sound region, with a legacy of compassionate care and innovation. With 10 hospitals and nearly 300 care sites, the organization is dedicated to healing the whole person through rigorous research, education, and collaboration.
Review a variety of claim types including Radiology, Ambulance, Physical Therapy, and Surgical for medical necessity and coverage.
Document medical rationale for payment or denial decisions using Medicare guidelines and established criteria.
Educate internal and external staff on medical review, terminology, coverage determinations, and coding.
We transform 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, we are built on integrity, collaboration, and excellence.
Conduct detailed outpatient coding audits for ED, SDS, OBS, and I&I services.
Identify coding discrepancies, root causes, and compliance risks to support appropriate reimbursement.
Provide technical guidance and training to coding staff to improve accuracy and quality.
This healthcare organization specializes in hospital outpatient coding, billing, and compliance services. It emphasizes accuracy, quality, and continuous improvement, with a collaborative culture that supports remote work.
Perform inpatient coding quality audits and reviews to ensure accuracy and compliance with coding guidelines and regulatory requirements.
Analyze audit results to identify coding trends and provide feedback, education, and coaching to internal coders and clients.
Participate in senior-level projects such as ICD-10 assessment and development of audit tools and training materials.
UASI provides healthcare auditing and consulting services, specializing in inpatient coding quality and education. With over 40 years of experience, the company has been recognized as a Top Workplace and offers a collaborative, remote work culture.
Conduct internal and external quality audits for ICD-10 code abstraction and identify clinical documentation improvement opportunities.
Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data and reviewing Risk Adjustment coding performance.
Maintain compliance with national coding standards and support CMS and Risk Adjustment Data Validation audits.
Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving its members. Founded in 2012, it cultivates an inclusive environment where employees can be their authentic selves.