Perform line-by-line review of high-dollar facility itemized bills and claim forms to identify billing errors.
Apply coding and reimbursement expertise to validate accuracy and ensure claims are paid correctly.
Serve as a subject matter expert for complex billing issues and drive payment integrity improvements.
Oscar is a health insurance company built on a full-stack technology platform with a focus on serving members. Founded in 2012, it fosters a culture of transparency and collaboration, working to change health 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.
Own Medicare billing, provider enrollment, and compliance for the group.
Review and release every claim before it goes to Medicare, checking codes and documentation.
Support physicians and their offices with billing questions, onboarding, and payment reports.
Integrated Complex Care Associates (ICC) is a California physician group that serves patients with complex health needs, led by each patient's own primary physician. The team is building its billing function from the ground up, so this role is the first full-time hire and offers a hands-on, independent culture.
Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.
Clover Health provides healthcare plans for seniors, using data and technology to improve care and lower costs. The company is a remote-first, mission-driven organization focused on diversity and inclusion.
Conduct routine and targeted coding audits for internal and outsourced vendors across ASC, hospital outpatient, and professional fee services.
Review ICD-10, CPT, HCPCS, and payer policies to ensure coding accuracy, compliance, and documentation support.
Prepare audit reports, identify trends, provide coder education, and support performance improvement initiatives.
Surgery Partners is a healthcare services company operating ambulatory surgery centers and related facilities across the United States. With more than 58 facilities, the company prioritizes compliance, quality, and a diverse, inclusive workplace.
Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance.
Review up to 25 diagnoses and procedures per record, classify errors with references.
Deliver facility audit reports and lead training sessions for coding staff and clinicians.
Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach.
Conduct audits of medical records for compliance with federal coding regulations and guidelines.
Provide education and training to providers on CPT, ICD-10, and HCPCS codes.
Act as an internal expert to ensure coding compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company collaborating with medical groups, health plans, and health systems. It aims to optimize physician practices and improve patient experiences through cloud-based technology and scalable operations.
Conduct detailed outpatient coding audits for ED, SDS, OBS, and I&I services.
Identify coding discrepancies, root causes, and compliance risks to support appropriate reimbursement.
Provide technical guidance and training to coding staff to improve accuracy and quality.
This healthcare organization specializes in hospital outpatient coding, billing, and compliance services. It emphasizes accuracy, quality, and continuous improvement, with a collaborative culture that supports remote work.
Audit inpatient and outpatient records for coding accuracy, documentation support, and reimbursement impact.
Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG, modifier, and bundling assignments across facilities.
Present findings and provide facility-specific coding education to leadership and stakeholders.
A large regional health network operates multiple medical facilities across the United States, focusing on accurate coding and compliance. The organization maintains a structured, regulated environment with an emphasis on quality improvement, education, and confidentiality.
Conduct independent coding audits of inpatient, outpatient, and professional fee services across multiple specialties.
Analyze sampled medical records to identify and substantiate coding, documentation, and compliance errors.
Provide targeted education and train-the-trainer sessions to strengthen coding practices.
This company provides medical coding auditing and validation services for Veterans Affairs medical centers, supporting healthcare data quality and compliance. It operates in a mission-driven environment focused on improving coding accuracy for veteran-serving facilities.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Conduct detailed audits of medical claims, billing records, coding, and clinical documentation.
Partner with healthcare system clients to resolve billing discrepancies and improve reimbursement.
Serve as a subject matter expert on Medicare, Medicaid, and commercial payer billing requirements.
Jaan Health is an AI-based care management company serving healthcare providers with its Phamily platform to deliver proactive care. It is a fast-growing, early-stage company built on five principles: care, curiosity, clarity, co-creation, and craftsmanship.
Analyze hospital claims to identify discrepancies between expected and actual insurance reimbursements.
Investigate underpayments and payment variances by examining coding errors, billing discrepancies, and payer policies.
Collaborate with insurance carriers and internal stakeholders to resolve billing issues and improve revenue recovery outcomes.
This partner company specializes in healthcare revenue integrity, helping hospitals recover appropriate reimbursement for services. The team fosters a collaborative, inclusive culture focused on continuous improvement and professional development.
Develop and implement education programs to improve coding and documentation practices.
Audit clinical documentation for compliance with AMA and CMS guidelines.
Provide training and guidance to providers, clinical staff, coders, and billing specialists.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It is recognized as a top workplace in healthcare and promotes a culture of belonging, support, and professional development.
Provide day-to-day leadership, technical support, and QA for Revenue Optimization Auditors.
Perform complex coding, billing, and revenue integrity audits and analyze data for opportunities.
Train and mentor new auditors, support process improvement, and escalate compliance concerns.
NAPA is a clinician-led leader in anesthesia and perioperative services, delivering exceptional patient experiences. They cultivate leaders, promote work-life balance, and celebrate diversity in a collegial environment.
Conduct clinical reviews of medical records during fraud investigations and program integrity initiatives.
Apply Medicare and Medicaid guidelines to determine appropriateness of payment coverage.
Compile investigative summary reports and provide training on medical terminology and policy interpretation.
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk. They are an equal opportunity employer committed to diversity and inclusion, maintaining a drug-free workplace.
Provide subject matter expertise on Payment Integrity claims processing edits, vendor edits, and reimbursement policies.
Respond to internal and external inquiries and disputes while documenting industry standard coding rules and recommending policy changes.
Collaborate with partners to scope, prioritize, and deliver solutions using data insights and process improvements.
Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members. Founded in 2012, the company fosters a culture of transparency, collaboration, and authenticity as an Equal Opportunity Employer.
Audit skilled nursing facility (SNF) medical claims for medically appropriate services using applicable guidelines and policies.
Document findings, generate audit letters, and support audit findings during the appeals process.
Work collaboratively with the audit team, clients, and contractors to improve medical policies and audit workflows.
Machinify is a healthcare intelligence company with expertise across the payment continuum, delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company combines an AI-powered platform with best-in-class expertise to drive down healthcare costs.
Post payments, adjustments, and denials from ERAs, EOBs, and lockbox files into customer PM systems.
Balance daily batches, reconcile to bank deposits, and resolve missing or mismatched ERAs.
Flag underpayments and denials, resolve unapplied cash, credit balances, refunds, and transfer balances.
Amperos is healthcare's first AI-native denial management and revenue recovery platform, using agentic AI to resolve claims end-to-end. Backed by a $16M Series A, it remains a small, early-stage team tackling a $260B+ problem with a mission-driven culture.
Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.