Manage design, build, testing, validation, maintenance, and ongoing support of Epic Resolute Hospital Billing and Electronic Remittance modules.
Collaborate with interdisciplinary workgroups to accomplish goals, focusing on Epic upgrades, enhancements, ticket queue responses, and break/fix duties.
Build relationships with colleagues, departments, and vendors, providing technical consulting and ensuring compliance with regulatory guidelines.
Emory Healthcare is a leading healthcare system in Atlanta, providing comprehensive medical services. They foster a supportive culture with extensive benefits, mentorship, and professional development opportunities.
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.
Provides leadership and oversight of oncology clinical research billing compliance, ensuring accurate billing practices.
Optimizes standardized billing compliance framework and directs work of CTMS Specialists and Billing Specialists.
Manages operational workflows including CTMS calendar development and Epic research billing protocol configuration.
The Knight Cancer Clinical Research organization supports translational clinical research to improve lives of people with cancer. OHSU is Oregon's only public academic health center and Portland's largest employer, focusing on patient care, research, and training.
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.
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.
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.
Provide advanced expertise and leadership for hospital billing and accounts receivable operations.
Ensure compliance with payer rules and regulatory requirements through quality assurance and audits.
Analyze payer trends and collaborate on process improvements to optimize revenue recovery.
Emory Healthcare is a healthcare system providing comprehensive medical services. They foster a supportive culture with benefits, mentorship, and leadership programs for employees.
Perform daily audits of RCM accounts to ensure accuracy and compliance with policies.
Review documentation, billing records, and account activity to identify errors and process gaps.
Communicate quality issues and provide constructive feedback to staff and department leaders.
Our partner focuses on revenue cycle management services for healthcare organizations. They foster a remote culture centered on accuracy, accountability, and continuous improvement, with a team dedicated to quality and compliance.
Lead portions of regulatory assessments, external audits, and accreditation processes for Commercial, Medicare, Medicaid, and Marketplace departments.
Act as primary point of contact for internal and external partners on regulatory activity, quality efforts, SOP development, and client delegation agreements.
Maintain regulatory gap status reporting, track work streams, and lead change management related to regulatory requirements.
Prime Therapeutics is a pharmacy benefit manager (PBM) with a purpose beyond profits, reimagining pharmacy solutions to connect care for those they serve. The company is a large, purpose-driven organization focused on simplifying healthcare and fostering a collaborative culture.
Review and abstract medical records for surgical CPT and ICD10 coding, ensuring accuracy and compliance.
Serve as a mentor for junior coders and handle escalated cases requiring complex coding expertise.
Work with multiple platforms including MD Cloud, Medaxion, and EMRs to manage edits, denials, and charge corrections.
US Anesthesia Partners is a healthcare company specializing in anesthesia services and revenue cycle management. They are a large employer with a focus on coding accuracy and compliance, fostering a collaborative and mentoring culture.
Investigate and resolve consumer and commercial billing issues, analyzing account discrepancies and negotiating settlements.
Communicate professionally with customers and provide timely updates on billing outcomes.
Document all investigations and collaborate with internal teams to improve billing processes.
They support healthcare organizations by ensuring accurate, timely, and effective resolution of complex billing matters. Their team is collaborative, remote, and focused on operational excellence with a supportive culture.
Own the full revenue cycle for a behavioral health practice, including charge entry, claim submission, payment posting, denial management, and collections.
Serve as the primary contact for patients and insurance payers, providing compassionate customer service and resolving billing concerns.
Prepare and present clear reports on key revenue cycle metrics to management, using Excel and PowerPoint.
Assist World connects businesses with remote virtual assistants, supporting a small, remote team culture with a focus on autonomy and results. The platform emphasizes no tracking and provides bonuses for performance.
Review inpatient claims to identify missed reimbursement opportunities based on ICD-10 coding accuracy.
Analyze hospital billing files and medical records to optimize DRG reimbursement.
Collaborate with leadership on case prioritization and workflow management.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations using intelligent automation. They are a multi-year Top Workplaces award recipient and have been on the Inc. 5000 list of fastest-growing private companies for eleven years.
Own the end-to-end revenue cycle, including claims, denials, appeals, and payment reconciliation.
Ensure accurate billing and compliance for Medicare and commercial payers.
Monitor KPIs, identify revenue opportunities, and reduce denials.
Medsien is a leading provider of scalable remote care management, enabling healthcare practices to enhance patient engagement and improve outcomes. They are a venture-backed company based in San Francisco, committed to innovation and collaboration.
Manage end-to-end billing relationships for supplemental products, including new business, renewals, and audits.
Collaborate with clients and partners to resolve billing issues and improve processes.
Drive collection of outstanding premiums and ensure accurate financial controls.
The Cigna Group is dedicated to improving the health and vitality of those they serve through their divisions Cigna Healthcare and Evernorth Health Services. As a large global company, they offer a comprehensive benefits package starting on day one and emphasize a culture of support and whole health.
Manage patient billing episodes, prior authorizations, and claim submissions.
Review and resolve claims issues, appeals, and eligibility with payors.
Ensure timely follow-up on outstanding accounts and document activities.
Acadia Healthcare's Comprehensive Treatment Centers (CTC) division operates 170+ CARF-accredited outpatient opioid treatment programs (OTPs) nationwide, serving more than 74,000 patients daily. As the leading provider of medication-assisted treatment in the nation, our team is at the forefront of the battle against the opioid epidemic.
Process medical records requests accurately and within required turnaround timelines.
Manage incoming payer communications and support billing operations, including refunds and claim-related activities.
Collaborate with internal teams to improve workflows and ensure compliance with healthcare requirements.
Our partner company is a mission-driven organization focused on improving access to quality care. They are a growing organization that values operational excellence and patient experiences.
Review inpatient coding (ICD-10-CM/PCS) to ensure accuracy and completeness for multiple clients.
Validate DRG assignments and optimize reimbursement while maintaining compliance with regulatory standards.
Collaborate with service line teams and client departments to improve documentation and meet production goals.
Kodiak Solutions specializes in healthcare finance, unclaimed property, risk management, and revenue cycle management. They use technology-driven solutions to help healthcare organizations streamline operations and improve patient care.
Identify opportunities to improve workflows, support automation, and scale billing processes.
Collaborate with internal teams and external EAP partners for accurate billing and payment processing.
Rula provides evidence-based mental healthcare, aiming to destigmatize and integrate mental health into overall well-being. They are a remote-first company hiring in most U.S. states, fostering a culture of inclusion and support.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote culture.