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.
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.
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.
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.
Manage client medical payment policies to ensure accuracy and compliance with CMS and payer guidelines.
Conduct periodic reviews and analyses of policy updates, coordinating with Medical Directors and presenting recommendations to clients.
Serve as the primary client liaison, addressing inquiries and maintaining detailed documentation of policy nuances.
Cotiviti is a healthcare data analytics company specializing in payment accuracy and medical policy management. The company fosters a collaborative remote culture and offers competitive benefits to support its team.
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.
United States
Unlimited PTO
12w maternity
12w paternity
Help hospitals and health systems understand how AI-powered CDI can improve documentation, boost revenue, and drive quality care.
Work closely with Customer Success to refine documentation workflows and help clients maximize their CDI programs.
Communicate directly with client CDI leaders to establish trust, address concerns, and demonstrate advanced knowledge of inpatient clinical documentation best practices.
SmarterDx builds clinical AI to help hospitals achieve 100% chart accuracy for revenue integrity. The company is a remote-first team with a mission to make healthcare more accurate, sustainable, and effective for everyone.
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.
Support patients with payment processing, billing education, insurance verification, and claims-related inquiries.
Accurately process payments, create payment plans, and interpret claim notes and billing outcomes.
Research account history to resolve billing issues and educate patients on insurance concepts.
Five Star Solutions is a staffing company connecting talent with roles in customer service and healthcare. They foster a remote work culture with a focus on compliance, empathy, and professional development.
Serves as a subject matter expert in clinical documentation quality, risk adjustment, and HCC coding integrity.
Performs prospective reviews of medical records to validate chronic conditions and ensure documentation accuracy.
Utilizes Epic and OurPractice Advisories to support accurate coding, HCC capture, and compliance.
UASI is a clinical documentation improvement consulting firm dedicated to improving the quality and accuracy of clinical documentation. They offer a collaborative, mission-driven environment with opportunities for professional growth.