Perform complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules.
Collaborate with operations consultants, RCM AR staff, and management to address Care Center payment performance audits and maximize cash flow.
Identify, monitor, and manage denial management trends, and work closely with Revenue Cycle Teams and payer representatives.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, focusing on reducing healthcare costs and improving outcomes.
Own the full revenue cycle for a behavioral health practice, including charge entry, claim submission, payment posting, denial management, and collections.
Serve as the primary contact for patients and insurance payers, providing compassionate customer service and resolving billing concerns.
Prepare and present clear reports on key revenue cycle metrics to management, using Excel and PowerPoint.
Assist World connects businesses with remote virtual assistants, supporting a small, remote team culture with a focus on autonomy and results. The platform emphasizes no tracking and provides bonuses for performance.
Own the end-to-end revenue cycle, including claims, denials, appeals, and payment reconciliation.
Ensure accurate billing and compliance for Medicare and commercial payers.
Monitor KPIs, identify revenue opportunities, and reduce denials.
Medsien is a leading provider of scalable remote care management, enabling healthcare practices to enhance patient engagement and improve outcomes. They are a venture-backed company based in San Francisco, committed to innovation and collaboration.
Oversee specialized teams supporting revenue integrity ROI activities, ensuring compliance with policies and timely completion.
Act as liaison between MRO and client audit and PFS leaders, managing workflow and client relationships.
Manage labor and expenditures to budget, and conduct performance reviews for direct reports and area managers.
MRO is the industry leader in Release of Information (ROI) and Health Information Management (HIM) services, partnering with hospitals and health systems nationwide. The company emphasizes compliance, operational excellence, and client-focused service.
Process medical records requests accurately and within required turnaround timelines.
Manage incoming payer communications and support billing operations, including refunds and claim-related activities.
Collaborate with internal teams to improve workflows and ensure compliance with healthcare requirements.
Our partner company is a mission-driven organization focused on improving access to quality care. They are a growing organization that values operational excellence and patient experiences.
Perform quality assurance reviews of patient identity management work and provide feedback to improve performance.
Monitor remote team quality results and provide summary reporting to leadership teams.
Collaborate on project procedure testing and review client-specific processes with remote teams.
The company specializes in healthcare data quality and patient identity management services. It fosters a culture of innovation, collaboration, and continuous improvement, with a focus on AI-enabled solutions.
Develop and maintain audit concepts by researching regulatory, coding, or payer policy changes and updating rule documents and code lists.
Perform QA reviews to ensure audit concepts comply with coding standards, payment methodologies, and payer policies prior to deployment.
Collaborate with cross-functional teams including operations, clinical, and client services to support policy execution and drive concept quality.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering value and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, we are a digital-first, AI-powered platform that reimagines what's possible in healthcare.
Lead the administration and optimization of Revenue Cycle Management (RCM) applications to ensure stable and efficient system operations.
Serve as primary liaison between business teams and third-party vendors to coordinate issue resolution and system enhancements.
Manage team workloads, establish escalation protocols, and ensure performance aligns with SLAs and KPIs.
Partner Company is a healthcare technology organization focusing on revenue cycle management. They foster a collaborative, team-oriented culture with a commitment to innovation and continuous improvement, though company size is not specified.
Conducts baseline, routine, and focused audits comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes.
Researches, interprets, and communicates federal and state laws and guidelines pertaining to CMS and Medicare.
Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs.
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.
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.
Manage complex financial clearance activities for healthcare patients, ensuring accuracy and compliance.
Serve as a subject matter expert in insurance verification, payer requirements, and financial resolution processes.
Provide mentorship and training to team members while collaborating with clinical teams to improve patient access.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It uses technology to ensure fair and objective application reviews, though the final hiring decisions are made by the employer.
Manage end-to-end billing relationships for supplemental products, including new business, renewals, and audits.
Collaborate with clients and partners to resolve billing issues and improve processes.
Drive collection of outstanding premiums and ensure accurate financial controls.
The Cigna Group is dedicated to improving the health and vitality of those they serve through their divisions Cigna Healthcare and Evernorth Health Services. As a large global company, they offer a comprehensive benefits package starting on day one and emphasize a culture of support and whole health.
Manage patient accounts and collections for medical services.
Communicate with patients and insurance companies to resolve billing issues.
Determine collectability and assist with financial assistance programs.
Air Methods provides air medical transport and patient billing services. The company is a large employer with a focus on compliance and patient financial counseling.
Performs clinical quality assurance review of daily clinical validation reviews and communicates differing audit decisions to ensure accuracy.
Integrates healthcare auditing principles and uses industry knowledge to substantiate decisions, reviewing medical records and applying clinical criteria.
Serves as a mentor to other QA auditors and may flex into initial audit or appeals roles as needed.
Cotiviti provides healthcare auditing and recovery solutions to ensure high quality recoverable claims. As a company, it employs a sizable workforce and fosters a culture of compliance, accuracy, and continuous improvement through professional skepticism and mentorship.
Manage and resolve claims rejections and denials, escalating trends as identified.
Verify patient eligibility and benefits, and coordinate with insurance payers.
Maintain compliance with HIPAA regulations and meet productivity standards.
Workit Health is an industry-leading provider of on-demand, evidence-based telemedicine care for addiction. They are a growing company with a dedicated team passionate about making judgment-free care accessible.
Lead quality initiatives, audits, and compliance programs to align with client and regulatory standards.
Analyze performance data and collaborate with cross-functional teams to implement process improvements.
Develop executive reports and tools to drive quality excellence and support operational accuracy.
The partner company operates in the US security and IT sector, focusing on quality and operational excellence. It maintains a dynamic, collaborative culture that values continuous improvement and client satisfaction.
Supervise day-to-day operations of clinical compliance auditors and specialists, serving as a liaison to senior management.
Coordinate orientation, training, and performance monitoring for clinical compliance auditors to promote professional growth.
Oversee development of UM and PHM agenda, audit guidelines, and ensure adherence to denial processes and compliance requirements.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, aiming to make healthcare affordable and improve patient health. It is a physician-led, remote-first organization that leverages AI and predictive analytics to empower partners in delivering high-quality, value-based care.
You process patient payments and manage payment plans with accuracy and empathy.
You handle insurance verification, claims support, and billing education for patients.
You research account issues and resolve billing discrepancies while maintaining professionalism.
Privia provides healthcare billing and payment solutions, helping patients with insurance claims and financial responsibilities. They operate with a remote team and emphasize compassionate, compliant service.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote culture.