Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues.
Proactively identify overpayments to ensure accurate claims payments on inpatient services.
Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.
They are reinventing health insurance by combining data with human empathy to keep members healthier. Clover Health believes the healthcare system is broken, so they've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most. They are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
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.
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.
Review and assign accurate ICD-10-CM, CPT, and HCPCS codes for medical diagnoses and procedures based on clinical documentation.
Ensure coding compliance with CMS guidelines, and state/federal regulations. Ability to write precise, professional, and well structured feedback to providers and team members.
Assist with claim reviews, denials, and coding-related audits to optimize revenue integrity.
Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical providers, who care for more than 200,000 patients statewide. Their mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare.
Auditing to ensure new provider and care center information is accurate.
Conducting Care Center audits based on the number of providers.
Identifying, monitoring, and managing denial management trends.
Privia Health is a technology-driven, national physician enablement company. They collaborate with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. Their platform is led by industry talent and cloud-based technology.
Assigns ICD-10 and CPT Codes and performs charge reconciliation.
Cooper University Health Care is committed to providing extraordinary health care. They are continuously discovering clinical innovations. Cooper offers career growth through professional development and is the employer of choice in South Jersey.
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.
Perform chart scrubbing and clinical documentation audits to ensure completeness and accuracy.
Review records to validate ICD-10 diagnosis coding and supporting clinical documentation.
Ensure compliance with PDPM (Patient-Driven Payment Model) and CMS guidelines.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging their extensive global network, they connect clients with highly qualified professionals, offering tailored services to meet clients' unique business needs.
Demonstrates knowledge of basic audit skills and adheres to Internal Audit Standards and UPH Internal Audit policies and methodologies.
UnityPoint Health is committed to their team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row. They champion a culture of belonging where everyone feels valued and respected, and believe in equipping you with support and development opportunities to deliver an exceptional employment experience.
Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards.
Ensure claims are processed correctly and on time with efficient management of records.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. As an affiliate of Dignity Health, they work hand-in-hand with physicians and providers throughout California to provide comprehensive health care services.
Responsible for maintaining the integrity, accuracy, and compliance of the hospital’s charge description master (CDM).
Ensures that all clinical services, supplies, and procedures are correctly coded and mapped for appropriate billing and revenue reporting.
Works closely with Clinical, Finance, Revenue Cycle, and IT Teams to analyze and implement new service request, coding updates, price changes, and regulatory modifications.
Ingalls Memorial Hospital is a world-class academic healthcare system. A skilled Medical Staff and talented employees dedicated to prevention, diagnosis, treatment and rehabilitation of illness and injury provide a firm foundation for our reputation for quality.
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.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
Codes and abstracts Outpatient records for data retrieval, analysis, reimbursement and research.
Codes and enters diagnostic and procedure codes into the designated coding and abstracting system.
Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR.
CommonSpirit Health has over 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen both inside our hospitals and out in the community.
Codes and abstracts Inpatient records for data retrieval, analysis, reimbursement and research.
Codes diagnostic and procedure codes into a designated coding and abstracting system utilizing the 3M encoder, as appropriate.
Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR.
CommonSpirit Health is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen both inside our hospitals and out in the community. With more than 700 care sites across the U.S., CommonSpirit is accessible to nearly one out of every four U.S. residents.
Performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record.
Trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function.
Acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of their team, you'll have the opportunity to join their quest for better health care, no matter where you work within the Northwestern Medicine system.
Performs the final reconciliation on clinic or provider visits.
Reviews, abstracts, and codes multiple or sub specialty services and complex or unusual cases, and assigns appropriate coding classifications.
Interacts with coding staff, business office, providers, hospital staff, clinic managers, and other clinical personnel on billing related issues.
University of Utah Health is a patient-focused organization that enhances the health and well-being of people through patient care, research, and education. They are a Level 1 Trauma Center and are nationally ranked and recognized for their academic research and quality standards.
Maintains the practice management system by entering accurate data, verifying and updating insurance and claims information, handles carrier correspondence, manages EOBs, and keys payments received into the system.
Prepares, reviews, submits, and follows up with clean claims to various companies/individuals.
Collects, posts, and manages patient account payments.
US Anesthesia Partners provides comprehensive anesthesia care. They are committed to clinical excellence and outstanding patient experience.
Reviewing and resolving missed or miscoded charges.
Ensuring coding and billing practices comply with guidelines.
Following Medicare/Medicaid and other payer requirements.
Marshfield Clinic Health System enriches lives through accessible, affordable, and compassionate healthcare, prioritizing patients' needs. They value connection with colleagues and community recognition, offering affordable living and leisure opportunities.