Auditing claims for medically appropriate services in inpatient and outpatient settings using medical review guidelines.
Documenting findings with reference to appropriate policies and rules.
Generating letters articulating audit findings.
Machinify is a healthcare intelligence company delivering value and efficiency to health plan clients across the US. Deployed by over 85 health plans representing over 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare cost reduction.
Perform detailed medical record reviews to validate DRG assignments and ensure billing accuracy.
Conduct clinical and coding audits to identify discrepancies and support cost containment.
Collaborate with quality teams and medical professionals to ensure compliance with payer regulations.
The company partners with healthcare organizations to ensure accuracy in medical coding and reimbursement. They offer a fully remote, supportive environment with comprehensive benefits and professional growth opportunities.
Perform daily audits on client data for completeness and accuracy of coding using clinical knowledge.
Respond to provider appeals and meet client turnaround time and KPI goals.
Utilize coding validation training to become familiar with claims payment policies and regulations.
Cotiviti is a healthcare analytics company that uses data-driven solutions to improve payment accuracy and quality in healthcare. The company offers a competitive benefits package and fosters a collaborative, fast-paced work environment.
Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
Cohere Health provides an AI-powered clinical intelligence platform that streamlines access to quality care by improving payer-provider collaboration and cost containment. The company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 and 2024.
Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Apply CMS guidance, coding guidelines, and industry standards during claim review, including hospital bill audits and itemized bill reviews.
Prepare appeal responses using applicable coding guidance and maintain required certifications and continuing education.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve access to healthcare. They are a dynamic growing organization promoting a collaborative and innovative work environment.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Review inpatient and outpatient medical records to support appeal submissions and apply payer-specific guidelines.
Document review findings accurately and meet assigned turnaround times while maintaining quality standards.
CorroHealth helps clients exceed their financial health goals by providing scalable solutions and clinical expertise across the reimbursement cycle. The company fosters a supportive culture that invests in professional development and personal growth.
Review and abstract professional medical records to ensure accurate code assignment.
Assign ICD-10-CM, CPT, HCPCS, and applicable modifiers following national and payer-specific guidelines.
Maintain coding quality metrics and participate in coding audits.
We reimagine how people access care by bringing it directly into their homes. We have supported over 2 million patients across 22 states, completed over 130,000 in-home visits, and raised over $125M from top investors.
Support accurate risk adjustment coding by performing first-pass reviews of member medical records.
Maintain compliance with CMS risk adjustment diagnosis coding guidelines and HCC coding standards.
Collaborate with a remote team and contribute to team success through proactive communication and continuous learning.
BlueCross BlueShield of Tennessee is Tennessee's largest health benefit plan company, helping members since 1945. As a remote-first organization, it fosters a culture of innovation and collaboration with a focus on employee well-being.
Assign accurate medical codes for inpatient/outpatient professional fee records with 95% or greater quality.
Work independently from a remote home office while meeting client productivity targets.
Maintain technical proficiency with VPN, multi-factor authentication, and office software.
UASI is a medical coding and auditing company with over 40 years of experience in the healthcare information management industry. They have been recognized as a Top Workplace for three consecutive years and emphasize professional growth and a supportive team culture.
Review inpatient and outpatient medical records to ensure accurate and compliant clinical documentation.
Collaborate with physicians and clinical teams to clarify diagnoses and support proper coding.
Maintain productivity targets and contribute to provider education initiatives to improve documentation quality.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It processes applications using AI to ensure fair review and shares top candidates with employers.
Conduct medical claim reviews using clinical information and established criteria to determine medical necessity and appropriate reimbursement.
Educate internal and external staff on medical reviews, coding procedures, and coverage determinations.
Participate in quality control activities and provide guidance to LPN team members.
Palmetto GBA is a healthcare service administrator and one of the nation's largest providers of high-volume medical claims and transaction processing. The company offers a diverse workforce, training programs for leadership, tuition assistance, and financial incentives.
Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records.
Review medical records for DRG/APC assignment, verify charge accuracy, and abstract clinical data.
Collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance.
Logan Health is a growing health system in Northwest Montana that provides quality, compassionate care through connection, service, and innovation. As a healthcare organization, they employ a team-oriented staff and value kindness, trust, collaboration, and excellence.
Review patient records and healthcare documentation to ensure compliance with regulatory standards.
Evaluate accuracy and completeness of clinical documentation, including OASIS guidelines and coding.
Collaborate with interdisciplinary teams to enhance patient outcomes through quality improvement initiatives.
Jobgether is a job platform that uses AI-powered matching to connect candidates with hiring companies. They partner with various employers to manage recruitment processes.
Review Home Health prior authorization requests for medical necessity using CMS regulations and Clover clinical guidelines.
Perform initial and concurrent clinical reviews, ensuring appropriate care in the least restrictive setting.
Collaborate with providers and internal teams to support timely decision-making and positive member outcomes.
Clover Health is a healthcare company that uses data and technology to provide affordable, high-quality insurance plans for seniors. The company fosters a remote-first culture with a diverse and mission-driven team focused on improving member outcomes.
Review and validate medical codes for accuracy and compliance with ICD-10, CPT, HCPCS, and other coding systems.
Provide expert coding guidance and support to clinicians and departments, serving as a resource for complex coding questions.
Conduct coding audits, generate productivity reports, and collaborate with IT and billing teams to resolve system issues.
Mission Healthcare is a home health and hospice company serving seven states, the largest of its kind in the western United States. They emphasize a culture of compassion, accountability, respect, excellence, and service (CARES) and are committed to diversity and inclusion.
Manages a remote team of behavioral health coding auditors, ensuring audit quality and team performance.
Serves as subject matter expert in behavioral health CPT coding, DSM-5 diagnostic coding, and payer requirements.
Drives operational strategy including capacity planning, staffing, and quality standards for behavioral health audit operations.
Machinify is a leading healthcare intelligence company delivering value and efficiency to health plan clients. Deployed by over 85 health plans, including many of the top 20, and representing over 270 million lives, they offer a flexible and trusting remote work environment.
Perform precise coding of telemedicine visits using CPT, ICD-10-CM, and HCPCS Level II codes in compliance with US healthcare standards.
Manage insurance claims processing, including submission, tracking, and resolution of denials or rejections.
Maintain accurate patient billing records and verify insurance eligibility and benefits.
Dr House is a trusted leader in telemedicine, providing high-quality virtual healthcare services across the United States. The company is a dynamic and fast-growing telemedicine firm that seeks to make healthcare more accessible and convenient for patients nationwide.
This advanced inpatient coder codes and abstracts medical records for reimbursement, research, and data analysis.
Uses 3M encoder and demonstrates competency in ICD-10, CPT-4, and HCPCS coding systems.
Meets quality and productivity standards while working in a remote, collaborative environment.
CommonSpirit Health operates over 700 care sites across the U.S., including clinics, hospitals, and virtual care services. With a focus on building healthy communities and advocating for the vulnerable, they employ a supportive, team-oriented workforce.
Perform clinical validation and medical record abstraction to ensure accuracy and compliance with CMS quality measures.
Identify and resolve data discrepancies in collaboration with internal teams and external vendors like Oracle Health.
Support timely regulatory submissions and cross-train across validation and abstraction functions for workload flexibility.
Banner Health is a large, nonprofit health care system in the US, providing hospital services, primary care, and research across multiple communities. With a network of hospitals and clinics, they employ skilled professionals using advanced technology to improve patient care.