Conduct quality assurance and audit planning for the WTC Health Program, reviewing claims and analyzing data to identify trends and issues.
Research federal payer coverage policies and develop program policies and procedures, maintaining the health plan codebook.
Collaborate with clinicians and subject matter experts to support medical management and claims review, ensuring accurate application of medical coding standards.
Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools.
Partner with data science teams to validate AI outputs and improve model performance.
Serve as a coding subject matter expert to support audit concept development and optimization.
Cotiviti is a healthcare analytics company specializing in payment integrity and data-driven solutions. The company fosters a collaborative culture and emphasizes innovation in healthcare audit and analytics.
Act as a subject matter expert on medical payment policy, analyzing client data and presenting new policy opportunities to health plans.
Collaborate with Client Medical Directors and internal teams to develop and advocate for adoption of medical policies that maximize value.
Prepare presentations, coordinate reviews, and inspire trust as a trusted advisor for the Health Plan's medical payment strategy.
Cotiviti is a healthcare analytics company that partners with health plans to optimize payment accuracy and medical policy through data-driven solutions. The company employs a global workforce and fosters a collaborative, client-focused culture.
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.
Conducts baseline, routine, and focused audits comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes.
Researches, interprets, and communicates federal and state laws and guidelines pertaining to CMS and Medicare.
Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs.
Develop and maintain system pricing for health care claims.
Analyze contract financial performance and coordinate internal/external audits.
Provide routine and ad hoc reporting to support business decisions.
HCSC is a health insurance company dedicated to expanding access to high-quality, cost-effective health care. With over 80 years of experience, they foster a collaborative and inclusive culture that values employee development and diversity.
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.
Conduct coding audits to ensure accuracy and compliance with ICD-10, CPT, and HCPCS guidelines.
Document findings with authoritative references and support corrective actions and education.
Stay current on payer rules and flag compliance risks to senior leadership.
Alteva RCM provides expert revenue cycle management and strategic solutions for healthcare providers. They foster a collaborative team culture committed to excellence, seeking passionate professionals to grow their careers.
Performs clinical quality assurance review of daily clinical validation reviews and communicates differing audit decisions to ensure accuracy.
Integrates healthcare auditing principles and uses industry knowledge to substantiate decisions, reviewing medical records and applying clinical criteria.
Serves as a mentor to other QA auditors and may flex into initial audit or appeals roles as needed.
Cotiviti provides healthcare auditing and recovery solutions to ensure high quality recoverable claims. As a company, it employs a sizable workforce and fosters a culture of compliance, accuracy, and continuous improvement through professional skepticism and mentorship.
Analyze claim selection processes and AI-enabled methodologies to optimize payment integrity outcomes.
Collaborate with data scientists and analytics teams to validate coding and reimbursement accuracy.
Serve as subject matter expert in healthcare billing, coding, and regulatory compliance.
Cotiviti is a healthcare payment integrity company that leverages data and AI to improve claim accuracy and compliance. They are a large organization with a collaborative culture focused on innovation and operational excellence.
Assist with retrospective and concurrent coding for PACE Dual participants.
Conduct pre-visit chart preparations and post-visit chart reviews.
Oversee audits and participate in provider education programs to ensure compliance with CMS risk adjustment diagnosis coding guidelines.
WelbeHealth provides seniors with the opportunity to continue living in their homes through its PACE program. The company employs a collaborative interdisciplinary team approach and values diversity and inclusion.
Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient and outpatient claims.
Conduct in-depth claims analysis using coding principles and electronic health information systems to ensure assigned codes are supported by documentation.
Meet quality and production standards and ensure compliance with quality management systems and ISO requirements.
Empower AI provides AI for government, helping federal agencies transform their workforce. With three decades of experience in Health, Defense, and Civilian missions, it is headquartered in Reston, VA and recognized as a 2024 Military Friendly Employer.
Coder III demonstrates proficiency in coding high acuity inpatient accounts and/or technical outpatient accounts.
Utilizes ICD-10-CM, PCS, HCPCS, CPT, and other coding references for accurate coding.
Supports Revenue Cycle goals for timely billing.
Cooper University Health Care is committed to providing extraordinary health care. We offer competitive rates, comprehensive benefits, and opportunities for career growth.
Monitor denial volumes, aging, and identify trends to improve coding quality processes.
Develop and implement new programs, processes, and standards to streamline workflows and enhance efficiency.
Collaborate with leadership to support annual and long-term strategy planning and execute departmental goals.
UnityPoint Health is a healthcare system dedicated to providing quality care and has been recognized as a Top 150 Place to Work in Healthcare. They foster a culture of belonging and offer support and development opportunities for their team members.
Review and assign diagnostic and procedural codes from medical records with 95% accuracy.
Serve as a liaison between billing and clinical sites to resolve coding discrepancies.
Train new employees and act as an expert resource for coding compliance questions.
Munson Healthcare is northern Michigan's largest healthcare system with eight award-winning community hospitals serving over half a million residents. They emphasize a culture of excellence, teamness, positivity, and creativity with over 5,000 employees.
Review and process medical, supplemental, or dental claims according to benefits, eligibility, and guidelines.
Validate accuracy of medical codes, assess eligibility, and evaluate authorizations in claim submissions.
Meet or exceed quality and productivity goals while working independently in a virtual environment.
The Cigna Group is a health services company dedicated to improving the health and vitality of those they serve. It is a large organization with a focus on innovation and employee well-being.
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.
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.
Review and abstract professional medical records to ensure accurate code assignment.
Assign ICD-10-CM, CPT, HCPCS, and applicable modifiers following national and payer-specific guidelines.
Maintain coding quality metrics and participate in coding audits.
We reimagine how people access care by bringing it directly into their homes. We have supported over 2 million patients across 22 states, completed over 130,000 in-home visits, and raised over $125M from top investors.
Review and interpret medical records to assign accurate ICD-10, CPT, and modifier codes for inpatient and outpatient encounters.
Collaborate with physicians and providers to resolve documentation gaps and strengthen coding accuracy.
Support audits, provider education, and revenue cycle performance through quality reviews and consistent productivity.
Jobgether uses AI-powered matching to connect candidates with hiring companies. They operate globally and focus on efficient recruitment through technology.
Audit outpatient and specialty claims to ensure coding accuracy, clinical validity, and medical necessity.
Utilize advanced coding knowledge and audit tools to identify billing issues and document findings.
Meet productivity and quality standards while recommending process improvements and new claim types.
Cotiviti is a healthcare analytics and auditing company that focuses on improving claims accuracy and reducing costs for clients. They are a mid-to-large sized employer with a culture that emphasizes quality, collaboration, and innovation in healthcare auditing.