Performs pre-admission, admission, and continued stay reviews using approved medical necessity criteria.
Coordinates patient care and communicates with physicians, patients, caregivers, and third-party payers.
Manages patient progression through the healthcare system and proactively works with payers to secure certification and minimize denials.
Ochsner Health is a leading not-for-profit healthcare provider in the Gulf South, with 46 hospitals and 370+ care centers. It employs more than 38,000 team members and has been recognized as a top workplace and the No. 1 hospital in Louisiana.
Perform retrospective reconciliation of complex CDI reviews and final coded records, ensuring clinical documentation integrity.
Collaborate with CDI specialists, coding professionals, and physicians to resolve documentation discrepancies and improve quality.
Monitor reconciliation metrics, support quality initiatives, and serve as a resource for documentation and coding guidance.
Tufts Medicine is an integrated health system combining academic and community medicine to deliver connected care across Massachusetts. With over 15,000 employees and caregivers, it fosters a culture of collaboration and innovation.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Provide clinical and administrative support to a remote healthcare team during weekends, holidays, and peak patient volume.
Review laboratory results, coordinate referrals and pharmacy communications, and document actions in the EMR.
Work independently while collaborating with physicians, PAs, and care coordinators to ensure continuity of care.
The partner company is a growing virtual care organization delivering remote healthcare services across Canada. Their team focuses on inclusive, accessible patient care and multidisciplinary collaboration.
Conduct comprehensive reviews of home health pre-claim review packages for Medicare compliance.
Document review outcomes with clinical rationale and meet a 7-business-day turnaround.
Maintain 98% accuracy and complete required training and quality assurance sessions.
Broadway Ventures is a consulting firm providing program management, technology, and innovative solutions to government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, it emphasizes integrity, collaboration, and excellence in its culture.
Review prior authorization cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
Perform medical reviews and utilization management to determine medical necessity for services and appeals.
Evaluate medical records and document decisions using clinical guidelines and protocol sets.
Educate members, providers, and staff on coverage determinations, medical terminology, and coding procedures.
Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. As part of BlueCross BlueShield of South Carolina, we've served clients for 70+ years and offer training and tuition assistance.
Address patient and DPOA inquiries via phone and patient portal, and assist with scheduling follow-up appointments.
Manage electronic health records, maintain patient rosters, and facilitate provider orders and prior authorizations.
Collaborate with the Curana interdisciplinary care team and handle incoming calls professionally.
Curana Health is a national leader in value-based care for senior living, offering on-site primary care and Medicare Advantage plans. Founded in 2021, it has grown to serve 200,000+ seniors in 1,500+ communities, with a team of 1,000+ clinicians and staff, ranking #147 on the Inc. 5000.
Review patient charts and verify eligibility for cardio-kidney-metabolic (CKM) conditions, releasing standing lab orders under the Regional ACCESS Director's authority.
Manage daily order queues with high clinical accuracy to maintain strict turnaround targets and prevent enrollment delays.
Act as a subject matter expert on lab ordering processes, identify friction, and partner with stakeholders to optimize workflows.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, they have become the largest network of independent primary care in the country, with a culture that is collaborative, inclusive, and remote-first.
Prepare comprehensive AWV charts and conduct face-to-face virtual visits via Zoom.
Review patient histories, medications, screenings, and assessments to identify care gaps.
Maintain accurate documentation and ensure compliance with Medicare, CMS, and HIPAA standards.
CareTalk Health is a fully remote, nationwide virtual medical practice that partners with Medicare Advantage plans to deliver Annual Wellness Visits and close care gaps. It is a fast-growing telehealth organization with a nationwide clinical team focused on making virtual care simple, reliable, and human.
Provide high-quality virtual nursing care through phone, video, and chat, including assessment and triage.
Develop individualized care plans, educate patients, and collaborate with providers.
Document patient interactions in the EMR and ensure compliance with regulations and safety standards.
Emory Healthcare is a comprehensive healthcare system offering virtual nursing and telehealth services. It is a large organization that prioritizes professional development, mentorship, and a supportive work environment.
Drive forward movement within the post-trial pipeline by proactively removing barriers and ensuring timely progression.
Obtain medical records and prescriptions from prescribers while maintaining accurate client records in CRM.
Communicate consistently with speech language pathologists, clients, and care providers to complete sales and secure funding.
Lingraphica is a mission-driven organization providing speech-generating devices to help people with communication impairments improve their quality of life. They are a leader in augmentative and alternative communication technology, with a fast-paced, goal-oriented culture focused on helping individuals, families, and care teams.
Perform quality audits on clinical documentation across clinical departments.
Collaborate with leadership to develop corrective action plans and provide 1:1 coaching.
Support organizational readiness for NCQA and other regulatory audits.
Oscar is the first health insurance company built around a full stack technology platform, focusing on serving members with a concierge-level experience. It started in 2012 and is an Equal Opportunity Employer cultivating an authentic, inclusive environment.
Conduct thorough medical record reviews for assigned patient population to ensure accurate DRG assignment and severity of illness documentation.
Author and manage compliant provider queries to resolve documentation gaps while adhering to AHIMA and ACDIS guidelines.
Educate multi-disciplinary care teams on documentation best practices and collaborate with HIM coding professionals to streamline workflows.
CommonSpirit Health is a large nonprofit Catholic healthcare organization that provides integrated health services. It has over 157,000 employees and delivers more than 20 million patient encounters annually, striving to create a more just and equitable healthcare system.
Manage communications between patients and doctors, including documentation, referrals, and labs.
Collaborate with clinical, operations, and customer service teams to resolve patient concerns quickly.
Provide clinical feedback on medications, labs, and side effects while supporting physicians.
Hone is an online medical clinic focused on transforming healthcare and enhancing longevity through virtual care. It is a remote-first, fast-paced company that values candid communication, collaboration, and calculated risk-taking.
Assess clinical documentation for compliance with AMA and CMS coding guidelines.
Validate clinical documentation and evaluate accuracy and timeliness of the billing process.
Investigate and identify opportunities for improvement and provide education to providers and staff.
UnityPoint Health is a healthcare organization providing services across Iowa, Illinois, and Wisconsin. It is recognized as a top place to work in healthcare and fosters a culture of belonging, development, and total rewards.
Conduct clinical audits for suspected fraud, waste, and abuse with high autonomy.
Document findings in formal reports, graphs, and audit logs, aligning with unit goals.
Develop and present FWA-related education to Oscar teams, ensuring compliance with regulations.
Oscar is a health insurance company built on a full stack technology platform, focused on serving members like a doctor in the family. Founded in 2012, it is a forward-thinking company that values diversity and innovation, with a culture of fostering belonging and support.
Assess clinical documentation for compliance with AMA and CMS coding guidelines.
Provide education and guidance to providers, clinical staff, and coders on documentation standards.
Analyze audit data, report findings, and collaborate with leadership to improve coding practices.
UnityPoint Health is a healthcare system providing medical services across Iowa, Illinois, and Wisconsin. It is recognized as a top workplace, committed to team member support, development, and a culture of belonging.
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.
Conducts appeals reviews of new evidence disputing medical review audit findings.
Documents and reports appeals results accurately, upholding or overturning determinations.
Serves as a subject matter expert, supporting training and process improvements.
Machinify is a healthcare intelligence company offering an AI-powered platform for health plan payment and clinical review. It serves over 85 health plans and over 270 million lives, with a culture of innovation and continuous improvement.