Conduct quality reviews and audit revenue cycle claims and workflows against established SOPs.
Develop, collect, and analyze quality improvement initiatives to support RCM operational functions.
Identify process deficiencies via analysis and trends, and deliver assessment results to leadership.
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 exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology.
Independently audit professional-fee coding for accuracy, compliance, and reimbursement impact.
Evaluate ICD-10-CM, CPT, HCPCS Level II, E/M services, modifiers, and professional components.
Prepare reports, deliver coding education, and maintain 95% audit accuracy.
A large regional healthcare network providing medical services across multiple facilities. The culture emphasizes independent auditing, high accuracy, and collaborative compliance education.
Audit inpatient and outpatient records for coding accuracy, documentation support, and reimbursement impact.
Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG, modifier, and bundling assignments across facilities.
Present findings and provide facility-specific coding education to leadership and stakeholders.
A large regional health network operates multiple medical facilities across the United States, focusing on accurate coding and compliance. The organization maintains a structured, regulated environment with an emphasis on quality improvement, education, and confidentiality.
Conduct independent coding audits of inpatient, outpatient, and professional fee services across multiple specialties.
Analyze sampled medical records to identify and substantiate coding, documentation, and compliance errors.
Provide targeted education and train-the-trainer sessions to strengthen coding practices.
This company provides medical coding auditing and validation services for Veterans Affairs medical centers, supporting healthcare data quality and compliance. It operates in a mission-driven environment focused on improving coding accuracy for veteran-serving facilities.
Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance.
Review up to 25 diagnoses and procedures per record, classify errors with references.
Deliver facility audit reports and lead training sessions for coding staff and clinicians.
Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach.
Conduct audits of medical records for compliance with federal coding regulations and guidelines.
Provide education and training to providers on CPT, ICD-10, and HCPCS codes.
Act as an internal expert to ensure coding compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company collaborating with medical groups, health plans, and health systems. It aims to optimize physician practices and improve patient experiences through cloud-based technology and scalable operations.
Conduct facility inpatient coding audits using MS-DRG and APR-DRG methodologies, providing evidence-based recommendations.
Identify coding quality and compliance opportunities while delivering coder education through the audit process.
Manage multiple cases concurrently, maintain accuracy, and uphold professional ethics and confidentiality.
Our partner provides healthcare organizations with high-quality, compliant coding practices through inpatient coding audits. They offer a collaborative, service-oriented environment focused on coding excellence and continuous professional development.
Audit surgical and procedural coding for accuracy, documentation support, and compliance with ICD-10-CM, CPT, and HCPCS guidelines.
Document findings with authoritative guidance, assess financial impact, and recommend corrective actions.
Deliver facility-specific coding education and collaborate with health information management leadership and facility stakeholders.
A healthcare organization is seeking a Surgery Coding Auditor to ensure accurate surgical coding and compliance. The company operates across multiple healthcare facilities in the US and emphasizes quality assurance, education, and process improvement.
Monitor coding prevalence and ensure compliance with CMS audit processes.
Conduct provider and coder level reviews to ensure accurate risk adjustment data submission.
Maintain tracking tools and assist in RADV audits and corrective action plans.
Alignment Health is a healthcare organization dedicated to transforming senior care, focusing on the chronically ill and frail. The company is fast-growing with a passionate team united in the mission to put seniors first.
Assess clinical documentation for compliance with AMA and CMS coding guidelines.
Provide education and guidance to providers, clinical staff, and coders on documentation standards.
Analyze audit data, report findings, and collaborate with leadership to improve coding practices.
UnityPoint Health is a healthcare system providing medical services across Iowa, Illinois, and Wisconsin. It is recognized as a top workplace, committed to team member support, development, and a culture of belonging.
Lead external customer audits and utilization management oversight activities as a subject matter expert.
Analyze complex UM data, investigate findings, and prepare evidence-based responses for regulators and accreditation organizations.
Collaborate with operational, technical, and client-facing teams to drive compliance and process improvements.
This company is a healthcare organization specializing in utilization management and regulatory compliance. It operates with a remote team across the United States, fostering a collaborative and improvement-driven culture.
Conduct internal and external quality audits for ICD-10 code abstraction and identify clinical documentation improvement opportunities.
Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data and reviewing Risk Adjustment coding performance.
Maintain compliance with national coding standards and support CMS and Risk Adjustment Data Validation audits.
Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving its members. Founded in 2012, it cultivates an inclusive environment where employees can be their authentic selves.
Serve as a Revenue Integrity resource for assigned clinical service lines and partner with various stakeholders to improve revenue capture.
Perform end-to-end assessments of workflows to identify opportunities for improvement and implement corrective actions.
Analyze data to identify trends, charging variances, and revenue optimization opportunities while maintaining knowledge of regulations and best practices.
The Wilshire Group is a healthcare consulting organization focused on helping clients improve revenue cycle performance through experienced professionals, practical solutions, and collaborative partnership. They are an equal opportunity employer that values a collaborative, professional, and inclusive work environment.
Conduct routine and focused audits of medical coding to ensure compliance with CMS, payer, and organizational standards.
Develop and deliver education and feedback to coders and providers to improve documentation quality and coding accuracy.
Assist with internal and external audit preparation and response, including documentation requests and validation reviews.
Sprinter Health reimagines healthcare by delivering care directly to patients' homes using marketplace and last-mile technologies. They have supported over 2 million patients across 22 states, completed 130,000 in-home visits, and raised over $125M from investors like a16z and General Catalyst, with a team of clinicians, technologists, and operators.
Audit medical records to ensure documentation supports level of service and compliance with coverage determinations.
Develop and implement educational programs for coding and documentation improvement.
Orient and audit newly on-boarded providers and programs.
Southcoast Health is a not-for-profit health system providing comprehensive healthcare across Southeastern Massachusetts and Rhode Island. With multiple facilities, they have been voted 'Best Place to Work' for 7 years in a row.
Review and analyze complete patient medical records to identify all diagnostic and procedural information.\n- Assign accurate diagnostic and procedural codes using encoder software to ensure proper MS-DRG assignment and sequencing.\n- Maintain compliance with coding guidelines and verify medical record completeness for accurate reimbursement.
Henry Ford Health is a leading academic health system providing a comprehensive continuum of care, including primary to complex care, virtual care, and health insurance. With 12 hospitals and hundreds of ambulatory locations across Michigan, it is headquartered in Detroit and committed to innovation and community impact.
Supervise a distributed medical coding team supporting eight VA medical centers across VISN 7.
Ensure coding accuracy and compliance through quality reviews, coder coaching, and corrective action plans.
Serve as primary liaison with VA HIMS leaders and manage productivity, billing issues, and reporting.
They provide medical coding and health information management support for Veterans Affairs medical centers. They lead large-scale remote coding operations with a structured, mission-driven culture focused on serving veteran populations.