Review clinical information for appropriateness, congruency, and accuracy.
Review and communicate OASIS edit recommendations to each clinician.
Provide customer service/education and act as a resource to Medicare Certified Offices.
BAYADA Home Health Care delivers home health care with compassion, excellence, and reliability. As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates, with 50 years of experience.
Responsible for submission of the patient’s medical record to CMS or their delegated representatives, other contracted agencies, patients, and privately subpoenaed charts.
Provide administrative support to the Director of Home Health in compliance with organization policies and procedures and applicable laws and regulations.
Develop and maintain tracking tools to assist management with monitoring progress on compliance and accreditation standards.
By The Bay Health, established in 1975, is a non-profit that set the standard for hospice in the U.S. by emphasizing the role of the patient in making important medical decisions. Their spectrum of home-based services includes Skilled Home Health Care, Palliative Care, Adult Hospice Care and Pediatric Care.
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Machinify is a healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They deploy a configurable, AI-powered platform and best-in-class expertise, serving over 85 health plans representing more than 270 million lives.
Responsible for coding procedures and entering charges to comply with regulations and internal policies.
Coordinate with Practice Coordinator and Revenue Integrity to assure all necessary documentation is present.
Participate in audits to evaluate if all selected codes are accurate and develop methodologies to improved coding issues.
Northside Hospital is an award-winning and state-of-the-art hospital that is continually growing. They are expanding the quality and reach of their care to patients and communities which creates more opportunity for healthcare professionals in Atlanta and beyond.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards with your expertise and training.
Review patient medical record information via population health tools to identify, assess, monitor and review network coding opportunities.
Dignity Health Management Services Organization (Dignity Health MSO) aims to build a system-wide integrated physician-centric, full-service management service organization structure. They provide management and business services, leveraging economies of scale and leading efforts in developing Medicaid population health care management pathways.
Ensuring the accuracy, integrity, and quality of coding practices within the HIM department.
Conducting thorough reviews of clinical documentation, coding, and billing processes to ensure compliance.
Educating and training coding staff on best practices and updates in coding guidelines.
Cooper University Health Care is committed to providing extraordinary health care. They focus on clinical innovations and access to facilities, equipment, technologies and research protocols, and offer competitive rates, compensation programs, benefits, and career growth.
Review patient records to ensure documentation aligns with medical, legal, regulatory, and insurance standards.\n- Abstract appropriate supporting documentation into abstraction tool.\n- Collaborate with healthcare providers or internal staff to clarify unclear or incomplete documentation.
Capital Blue Cross promises to go the extra mile for its team and community, and its employees consistently vote it one of the “Best Places to Work in PA”. The company offers a flexible environment where health and wellbeing are prioritized and invests in training and continuing education.
Supports coding and documentation quality assurance.
Performs internal audits to assess compliance and quality.
Researches coding, billing, and charging compliance issues.
Presbyterian Healthcare Services is dedicated to improving the health of patients, members, and communities. They are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group, employing nearly 14,000 individuals.
Analyzes and Audits Claims; Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities.
Effectively Utilizes Audit Tools; Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
Meets or Exceeds Standards/Guidelines for Productivity and Accuracy/Quality.
Cotiviti is a company that focuses on Coding & Clinical Chart Validation for Inpatient audits. They offer a competitive benefits package to address a wide range of personal and family needs.
Perform comprehensive medical record and claims review to make payment determinations for Medicare PART A.
Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides federal agency leaders with tools to elevate their workforce's potential through meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions.
Review and analyze medical records to ensure coding accuracy in a timely fashion
Identify opportunities for improvement in coding models
Understand and apply coding guidelines to assign appropriate codes to diagnoses and procedures as supported by clinical documentation
SmarterDx builds clinical AI that is transforming how hospitals translate care into payment. Founded by physicians in 2020, their platform connects clinical context with revenue intelligence, helping health systems recover millions in missed revenue, improve quality scores, and appeal every denial.
Perform comprehensive reviews of patient charts to identify gaps in documentation.
Collaborate with providers and clinical staff to educate them on accurate documentation.
Maintain accurate records of chart reviews, coding opportunities identified, and outcomes.
Bluestone delivers exceptional care to patients living with complex, chronic conditions and disabilities. Our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver preventative, proactive and tailored care. Bluestone has been named to the Star Tribune's Top Workplace list for the 13th year in a row and also achieved Top Workplace USA 2021-2025!
Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types
Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans
Perform necessary research to provide to the client to support findings.
UASI is recognized as a Top Workplace. With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we’ve built and the long-term success of our dedicated team.
Review clinical documentation and assign accurate ICD-10-CM, HCPCS, and CPT codes to encounters
Ensure compliance with CMS, payer, and risk adjustment coding guidelines
Collaborate with clinicians and billing staff to clarify documentation or coding discrepancies
Main Street Health is the nation's largest provider of value-based care exclusively serving rural America. They partner with rural primary care doctors and reinforce the importance of trust and relationship-driven care in rural communities.
Lead prospective claim review audits related to clinical DRG coding compliance and readmissions programs.
Act as Subject Matter Expert to counsel other team members across Clover on clinical coding guidelines.
Collaborate with teams across Clover to ensure provider understanding of Payment Integrity recommendations.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most; they are passionate and mission-driven individuals.
Conduct thorough reviews of medical records to support program eligibility determinations.
Apply established clinical criteria and program-specific guidelines to evaluate medical necessity and eligibility determinations.
Accurately abstract and document relevant clinical findings, diagnoses, procedures, and treatment history from the medical record.
Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. Daymark’s comprehensive, personalized cancer care platform empowers patients with dedicated care navigation, symptom-focused support, behavioral health care, and social resources.
Abstract information from patient medical records to assign correct codes and charges to outpatient surgical records, and/or observation cases.
Assign correct CPT, ICD-10-CM; HCPCS or ICD-10-PCS and DRGs for facility and/or professional charges, which would involve complex procedure and diagnostic coding within highly specialized coding areas.
Monitor activity for compliance with federal and/or state laws regarding correct coding set forth by CMS and Oregon Medical Assistance program (OMAP).
OHSU is Oregon's only public academic health center. As Portland's largest employer, they offer learning and advancement opportunities in a system of hospitals and clinics across Oregon and Southwest Washington.
Perform comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment.
Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides AI tools for government to elevate workforce potential. They have three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.
Organizes and prioritizes assigned work to ensure completion within the assigned time frame.
Reviews charts and medical records, assigning ICD and CPT code combinations to each data element.
Audits for documentation opportunities and queries clinical staff to fill in any gaps.
Riverside Health System's mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team, offering care at all stages of life, in hundreds of locations.