Analyze and process complex medical claims in accordance with program policies and procedures.
Apply critical thinking to adjudicate claims and resolve issues through collaboration with internal departments.
Maintain confidentiality of patient records and ensure thorough record-keeping in compliance with HIPAA regulations.
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business providing expert program management, technology, and consulting solutions. As a small business, they emphasize integrity, collaboration, and excellence in serving government and private sector clients.
Support quality assurance and audit planning for the WTC Health Program
Analyze claims data to identify trends and recommend improvements
Maintain health plan codebook and ensure accurate medical coding standards
Advanced Technologies & Laboratories International, Inc. (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. The company offers a competitive total compensation package and invests in professional growth through tuition reimbursement and certification programs.
Manage high-value medical claims, denials, and appeals to ensure accurate and timely reimbursement.
Analyze unpaid/underpaid claims, investigate billing errors, and communicate with insurance payors via portals, phone, and email.
Maintain detailed documentation, process updates, and collaborate with internal teams to resolve complex accounts receivable issues.
Our partner operates within the healthcare revenue cycle, ensuring accurate reimbursement for medical services. They are a collaborative team focused on improving financial outcomes and maintaining compliance with healthcare regulations.
Understand plan formulary design and contracting potentials for client setups.
Analyze claims data to ensure accuracy of contract processing and provide recommendations for optimization.
Support sales, RFP, audits, and client operations as a subject matter expert.
Lumicera Health Services is an innovative specialty pharmacy solutions provider focused on transparency and stewardship. The company fosters a creative and diverse team environment.
Provide effective and timely customer service for members, providers, and insurers regarding health care claims.
Ensure timely follow-up and organize health insurance paperwork and medical records.
Communicate status updates, negotiate with providers, and appeal claim denials on behalf of plan members.
Included Health is a healthcare company delivering integrated virtual care and navigation. They aim to raise the standard of healthcare for everyone, offering care guidance, advocacy, and personalized virtual and in-person care.
Research and resolve insurance claims to maximize cash collections and minimize denials.
Maintain worklists and assignments based on performance targets and quality scores.
Interface with payers and internal partners to conduct follow-up and escalate items promptly.
USACS is a clinician-centric provider of hospital-based emergency and inpatient medicine, serving 11 million patients annually in 400+ programs across 27 states. They are a large practice prioritizing personal and professional satisfaction with a culture of robust support.
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.
Perform advanced healthcare payment audits by analyzing claims data and identifying discrepancies.
Develop and improve audit concepts focused on payment accuracy and reimbursement policies.
Collaborate with audit, engineering, and business teams to ensure accurate findings and process improvements.
Jobgether is an AI-powered job matching platform that uses technology to connect candidates with roles. The company operates remotely and focuses on efficient, objective hiring processes.
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.
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.
Lead analysis and delivery of coding, billing, and policy solutions from requirements to implementation.
Translate complex medical coding concepts into clear documentation and actionable deliverables.
Act as a key liaison between operations, technical teams, and client stakeholders to ensure alignment.
Partner company focused on healthcare operations, medical coding, and policy. They offer a fully remote environment with comprehensive benefits and professional development opportunities.
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.
Conduct revenue cycle assessments and provide actionable insights for enhancement.
Research, analyze, and resolve complex cases and problem accounts.
Develop good working relationships with clients and lead small groups on outsourced billing engagements.
Wipfli is a professional services firm providing accounting, tax, and consulting services. They are a large firm with a culture that emphasizes flexibility, relationships, and individual growth, making people feel valued.
Identify, research, process, and resolve customer inquiries regarding health insurance benefits, claims, and eligibility.
Analyze medical records and apply medical necessity criteria to determine the appropriateness of benefit requests.
Maintain accurate records, meet quality and timeliness standards, and coordinate with internal departments and external organizations.
Blue Cross Blue Shield of Arizona provides health insurance products and services to individuals, families, and businesses, aiming to inspire health and make it easy. The company has been recognized as a Healthiest Employer and has transformed healthcare for over 80 years with teams in Phoenix, Tucson, Chandler, and Flagstaff.