Lead the strategy and execution of provider-facing risk adjustment initiatives.
Partner with teams like Network, Data Science, and external providers for cross-functional program delivery.
Analyze provider performance to identify opportunities and develop improvement plans.
Oscar is a health insurance company built around a full-stack technology platform focused on serving its members. Founded in 2012, Oscar is a sizable organization that fosters a culture of authenticity and belonging.
Monitor coding prevalence and ensure compliance with CMS audit processes.
Conduct provider and coder level reviews to ensure accurate risk adjustment data submission.
Maintain tracking tools and assist in RADV audits and corrective action plans.
Alignment Health is a healthcare organization dedicated to transforming senior care, focusing on the chronically ill and frail. The company is fast-growing with a passionate team united in the mission to put seniors first.
Oversee credentialing workflows, quality, and compliance standards to ensure provider satisfaction and regulatory adherence.
Develop effective credentialing strategies based on data analysis, regulatory requirements, and operational observations.
Manage credentialing staff, provide coaching and feedback, and drive turnaround time improvement initiatives.
Sutherland is a global digital transformation company combining AI, automation, cloud engineering, and advanced analytics for iconic brands. It creates over 200 inventions and pairs human expertise with AI to unlock performance and deliver measurable results.
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.
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.
Lead a production-focused pod of Operations Analysts and Credentialing Specialists, owning day-to-day credentialing operations.
Drive team performance by monitoring speed, quality, and efficiency metrics, ensuring SLAs are consistently met.
Coach, mentor, and train team members, conducting daily standups and weekly performance reviews.
CertifyOS builds the data infrastructure for modern healthcare, automating provider licensing, credentialing, and network monitoring. It is backed by leading investors and values authenticity, accountability, collaboration, results, and openness to feedback.
Supervise a distributed medical coding team supporting eight VA medical centers across VISN 7.
Ensure coding accuracy and compliance through quality reviews, coder coaching, and corrective action plans.
Serve as primary liaison with VA HIMS leaders and manage productivity, billing issues, and reporting.
They provide medical coding and health information management support for Veterans Affairs medical centers. They lead large-scale remote coding operations with a structured, mission-driven culture focused on serving veteran populations.
Accurately assign and sequence ICD-10-CM, CPT, and HCPCS codes for outpatient medical records and encounters.
Ensure coding compliance with legal, regulatory, and organizational standards while initiating physician queries for documentation clarity.
Maintain productivity, quality, and confidentiality standards while supporting team collaboration and professional development.
CommonSpirit Health is a nonprofit Catholic healthcare organization delivering integrated health services. With more than 157,000 employees, 45,000 nurses, and 25,000 physicians across 24 states, it fosters a culture of compassion, innovation, and community service.
Supervise and train the credentialing associate team to ensure high performance.
Document and refine insurance credentialing workflows and processes.
Collaborate with the Credentialing Team Lead and partners to monitor metrics and resolve issues.
BetterHelp is the world's largest online therapy service, connecting millions of people with licensed therapists to make mental healthcare more accessible. As part of Teladoc Health, it offers startup energy with the support of a large company and a diverse, collaborative culture.
Act as the main point of contact for VA HIMS staff and lead a remote coding team across eight facilities.
Assign work, monitor turnaround times, and conduct ongoing quality reviews of at least 5% of coded data.
Train coders on VA policies and VistA/CPRS workflows and prepare monthly and quarterly reports.
Aptive Resources provides healthcare staffing and program support to federal agencies, including coding services for Veterans Affairs medical centers. As part of a Service-Disabled, Veteran-Owned Small Business joint venture, the company emphasizes an agile, mission-focused, results-driven approach.
Conduct clinical documentation reviews to ensure compliance with coding guidelines and regulations.
Provide education and training to providers and coding staff on documentation standards.
Analyze data and report findings to leadership to improve coding accuracy.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It has been recognized as a Top 150 Place to Work in Healthcare and fosters a culture of belonging.
Lead enterprise-wide quality strategy and compliance excellence, driving design, implementation, and continuous improvement of the PACE quality program.
Partner cross-functionally with Analytics, Compliance, and Operations to turn complex data into actionable insights and elevate quality.
Oversee Quality Operations teams, regulatory reporting, and corrective action plans to ensure participant safety and readiness.
WelbeHealth serves communities' most vulnerable seniors through PACE programs, focusing on participant-centered care. The company values pioneering spirit and offers a collaborative culture with comprehensive benefits and a commitment to diversity and inclusion.
Manage a large operations team supporting VA CCN Credentialing and Provider Data Loading.
Define operational strategy and align priorities with business goals for efficient, cost-effective infrastructure.
Collaborate across Provider teams and Humana Military to improve manual work, enhance data quality, and guide automation priorities.
Humana is a leading U.S. healthcare company offering insurance and healthcare services through its Humana Insurance and CenterWell brands. It is a large organization focused on improving health outcomes and supporting associates with competitive benefits.
Conduct QDI review of assigned inpatient cases and identify clinically supported documentation opportunities in real time.
Communicate directly with physicians and APPs on documentation and quality risk adjustment gaps.
Manage daily review queues and support provider education and calibration activities.
Tendo builds software that improves the care journey for patients, clinicians, and caregivers. It is a fast-growing, mission-driven company recognized as a Forbes Top Startup Employer, with a culture that enables teams and individuals to thrive.
Oversee inpatient coding operations, including personnel management and workflow optimization.
Monitor performance metrics like DNB reports and timely filing to support financial health.
Ensure regulatory compliance and collaborate with HIM, IT, and CDI teams on complex coding issues.
CommonSpirit Health operates more than 700 care sites across the U.S., making care accessible to nearly one in four residents. The organization is driven by compassion and a commitment to building healthy communities and advocating for the vulnerable.
Develop and lead the enterprise HEDIS strategy, including measures influencing Medicare Advantage Star Ratings.
Oversee the full HEDIS lifecycle from data acquisition to audit readiness and digital quality measurement.
Build cross-functional improvement initiatives and provider performance strategies to drive quality outcomes.
Capital Blue Cross is a health insurance company and independent licensee of the Blue Cross Blue Shield Association, focused on improving the health and well-being of its members and communities. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."
Lead multiple Team Leads overseeing credentialing operations, ensuring efficiency, accuracy, and compliance.
Own client health KPIs, drive performance metrics, and resolve escalations to ensure SLAs are met.
Partner with internal teams to optimize workflows, implement process improvements, and ensure business continuity.
CertifyOS builds the data infrastructure that powers modern healthcare by automating provider licensing and credentialing. Backed by leading investors, they have a high-ownership team focused on solving real infrastructure problems for millions of patients.
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.
Leads and develops a team of Medical Directors and Clinical Directors driving clinical strategy across enterprise value-based care contracts.
Owns clinical performance outcomes, resource deployment, and strategic market relationships.
Recruits and mentors clinical leaders while representing the clinical voice in company-wide strategy.
Aledade PBC is a public benefit corporation that empowers independent primary care practices by building value-based care contracts and technology. Founded in 2014, it is the largest network of independent primary care in the U.S. and fosters a collaborative, inclusive, remote-first culture.
Hire and manage a team of Oscar colleagues with direct responsibility for performance management, growth, and development.
Monitor operational KPIs, conduct root-cause analysis, and construct action plans to drive team performance.
Serve as a central communicator by leading team huddles and connecting colleagues to Oscar's mission, vision, and values.
Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members. They started in 2012 to create a kind of health insurance company that behaves like a doctor in the family, fostering an inclusive culture where people can be their most authentic selves.