Utilizing healthcare experience to perform audit recovery procedures.
Identifying and validating incorrect claim payments.
Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings.
Cotiviti Healthcare is the payment accuracy expert, working with healthcare organizations to recover money, improve processes, strengthen relationships, and maximize their value. They are a well-established company with competitive pay, opportunities to develop professionally, and excellent benefits.
Assess and Analyze daily charge activity for assigned area.
Works with the Revenue Integrity Manager on quality assurance and auditing of charge activity within IHIS.
Anesthesia Reconciliation; analysis of charge sessions for submission to Central Coding Department for revenue capture.
Ohio State University Physicians (OSUP) provides exceptional patient care while fostering a collaborative work environment through over 100 outpatient center locations. OSUP fosters a culture grounded in the values of inclusion, empathy, sincerity, and determination, with a team including more than 1,800 employees.
Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. The Coherenauts who succeed here are empathetic and believe diverse, inclusive teams make the most impactful work.
Source, interpret, and scope new payment integrity policies.
Prioritize policy updates based on savings potential and client impact.
Quantify and communicate policy value through data-driven analysis.
Rialtic, Inc. focuses on healthcare payment expertise, client strategy, and product innovation. They seem to have a culture that values collaboration and impact, although the job post doesn't specify size/employees.
Collect, analyze, and interpret clinical, operational, and financial data to assess payer performance and trends.
Maintain SOPs, payer playbooks, internal how-to guides, and reference materials.
Translate front-line payer knowledge into scalable process improvements.
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies and provide care for 10 million people.
Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
Identify and document systemic payer issues and trends affecting reimbursement.
TREND Health Partners is a tech-enabled payment integrity company. They facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment.
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.