Responsible for the systematic review of anesthesia records to ensure accuracy, completeness, and compliance with regulatory and institutional standards.
Verifies that all required documentation, provider signatures, and charges are present and appropriately supported.
Plays a key part in supporting quality assurance and regulatory compliance within the anesthesia department and assists with other auditor duties.
Manages medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Utilizes clinical background to address the clinical denials, as well as write sound, compelling factual arguments for appealing denials.
Responsible for maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria, as well as filing compliant appeals.
Shriners Children’s respects, supports, and values each other. They are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact and were named as the 2025 best mid-sized employer by Forbes.
Review and audit clinical documentation for accuracy, timeliness, and regulatory compliance.
Ensure documentation meets Medicare Conditions of Participation, state regulations, and accreditation standards.
Lead and support Quality Assurance and Performance Improvement initiatives, tracking key clinical and operational indicators.
They are fixing US healthcare by building an AI-native physical care platform, starting with home health. The company is automating administrative work with AI to create a fundamentally different cost structure than incumbents, enabling them to serve more patients.
Evaluate and present audit results and educational instruction to physicians, coders, and staff.
Review clinical documentation to ensure adherence to billing guidelines and internal coding policies.
Provide instruction on documentation standards and correct use of CPT‑4 and ICD‑10 codes.
Pediatrix Medical Group is a leading provider of specialized healthcare for women, babies, and children. Since 1979, they've grown into a national, multispecialty medical group with a commitment to coordinated and compassionate care, bolstered by investments in research, education, and safety.
Develop and maintain standard operating procedures and conduct training for revenue cycle teams to uphold best practices.
Perform audits on payer payments and fee schedules to ensure accurate reimbursement and identify denial trends affecting revenue.
Manage multiple priorities including special projects, Salesforce cases, and process documentation to support key performance goals.
Privia Health is a national physician enablement company that uses technology and scalable operations to help medical groups deliver high-value care in-person and virtually. The company, led by top talent and physician leaders, has a cloud-based platform focused on improving patient outcomes and provider well-being.
Primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements.
Assist with data collection, analysis and reporting for process improvement efforts.
Plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.
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. Cohere Health has a supportive, growth-oriented environment and diverse, inclusive teams.
Perform inpatient coding audits and review services remotely.
Identify trends and suggest corrective action plans.
Provide in-service education to clients on coding trends.
UASI has over 40 years of experience and enduring partnerships with its valued clients. The company was recognized as a Top Workplace by the Cincinnati Enquirer in 2022, 2023 and 2024, with a dedicated team and long-term success.
Conduct objective medical case reviews using standardized assessment criteria.
Evaluate the timeliness and appropriateness of care provided.
Identify quality improvement opportunities.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. It is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB).
Improve key performance metrics for the focused area within the revenue cycle.
Conduct audits of all revenue cycle processes, vendors, and technology.
Determine root cause of issue and appropriateness of actions taken, assist in corrective action plan development.
ATI Physical Therapy partners with business leaders to improve healthcare. They focus on positive change throughout the revenue cycle and offer competitive benefits.
Provide independent medical documentation review and functional capacity analysis to support RA determinations under the Rehabilitation Act of 1973 and aligned with EEOC.
No patient care, no medical exams, record based review only (paper file review).
Ability to clearly communicate medical findings in written form for non-clinical review.
AdNet/AccountNet, Inc. is an 8(a), WOSB, and WBE-owned management consulting firm founded in 1990. We blend the best people with the ongoing demands of the workplace by providing high-quality staffing and executive search services.