Provide subject matter expertise on Payment Integrity claims processing edits, vendor edits, and reimbursement policies.
Respond to internal and external inquiries and disputes while documenting industry standard coding rules and recommending policy changes.
Collaborate with partners to scope, prioritize, and deliver solutions using data insights and process improvements.
Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members. Founded in 2012, the company fosters a culture of transparency, collaboration, and authenticity as an Equal Opportunity Employer.
Assign and verify CPT, ICD-10 CM coding and modifiers based on documentation, ensuring compliance with official coding guidelines.
Resolve claim edits and denials, monitor charge capture volumes, and work with providers and clinic staff to ensure accurate charge capture.
Act as a subject matter expert in one or more specialties, identify trends and educational opportunities, and may train other coders.
Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children, providing a wide range of care from routine visits to life-saving treatments. The organization fosters a diverse and inclusive culture and seeks individuals committed to its vision of the healthiest kids in the country.
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.
Apply senior-level expertise to code inpatient and outpatient professional fee services across multiple specialties, assigning CPT, HCPCS, and ICD-10 diagnosis codes.
Review documentation to resolve edits in work queues and analyze denials for corrected claims or appeals.
Collaborate with clinic supervisors, providers, and Revenue Management to resolve coding issues and ensure compliance.
CommonSpirit Health is a nonprofit health system with more than 700 care sites across the U.S., serving nearly one out of every four U.S. residents. The organization is committed to building healthy communities and innovating healing both inside hospitals and in the community.
Perform line-by-line review of high-dollar facility itemized bills and claim forms to identify billing errors.
Apply coding and reimbursement expertise to validate accuracy and ensure claims are paid correctly.
Serve as a subject matter expert for complex billing issues and drive payment integrity improvements.
Oscar is a health insurance company built on a full-stack technology platform with a focus on serving members. Founded in 2012, it fosters a culture of transparency and collaboration, working to change health care.
Serve as an expert-level coder for complex inpatient records, ensuring accurate data retrieval and reimbursement.
Resolve billing inquiries, manage DRG denials, conduct audits, and support revenue cycle integrity.
Mentor coding staff and collaborate with management on training, education, and process improvements.
CommonSpirit Health operates more than 700 care sites across the U.S., from clinics and hospitals to home-based and virtual care services. With a mission to build healthy communities and advocate for the poor and vulnerable, they foster a culture of compassion and innovation.
Edit advertising, promotional, and educational projects to ensure accuracy of spelling, grammar, punctuation, syntax, and context.
Collaborate with marketing, legal, regulatory, and medical stakeholders to resolve content barriers and ensure timely approval.
Utilize Veeva, Adobe software, InCopy, PowerPoint, Excel, and Word to manage content in near real time.
LogicSource is a leader in sourcing and procurement services, helping companies increase profits through better buying. It is operated by a 500-person collective of procurement professionals with a collaborative, supportive culture and a commitment to professional growth.
Accurately assign and sequence ICD-10-CM, CPT, and HCPCS codes for outpatient medical records and encounters.
Ensure coding compliance with legal, regulatory, and organizational standards while initiating physician queries for documentation clarity.
Maintain productivity, quality, and confidentiality standards while supporting team collaboration and professional development.
CommonSpirit Health is a nonprofit Catholic healthcare organization delivering integrated health services. With more than 157,000 employees, 45,000 nurses, and 25,000 physicians across 24 states, it fosters a culture of compassion, innovation, and community service.
Conduct clinical documentation reviews to ensure compliance with coding guidelines and regulations.
Provide education and training to providers and coding staff on documentation standards.
Analyze data and report findings to leadership to improve coding accuracy.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It has been recognized as a Top 150 Place to Work in Healthcare and fosters a culture of belonging.
Code outpatient encounters using ICD-10-CM, CPT-4, and HCPCS Level II.
Assign E/M levels, apply NCCI bundling edits, and ensure accurate diagnoses.
Maintain 95% accuracy and meet facility turnaround times.
Aptive Resources provides healthcare staffing and program support for federal agencies, including VA medical centers. Arrow ARC is a Service-Disabled, Veteran-Owned Small Business with a mission-focused culture.
Conduct routine and targeted coding audits for internal and outsourced vendors across ASC, hospital outpatient, and professional fee services.
Review ICD-10, CPT, HCPCS, and payer policies to ensure coding accuracy, compliance, and documentation support.
Prepare audit reports, identify trends, provide coder education, and support performance improvement initiatives.
Surgery Partners is a healthcare services company operating ambulatory surgery centers and related facilities across the United States. With more than 58 facilities, the company prioritizes compliance, quality, and a diverse, inclusive workplace.
Develop and implement education programs to improve coding and documentation practices.
Audit clinical documentation for compliance with AMA and CMS guidelines.
Provide training and guidance to providers, clinical staff, coders, and billing specialists.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It is recognized as a top workplace in healthcare and promotes a culture of belonging, support, and professional development.
Code inpatient professional and nursing home services using CPT, ICD-10-CM, and HCPCS.
Apply surgical package rules, E/M guidelines, and NCCI edits with proper modifiers.
Maintain 95% accuracy and enter codes in VistA after reviewing CPRS documentation.
Aptive Resources provides health care staffing and program support to federal agencies, including the Veterans Health Administration. It is a certified Service-Disabled, Veteran-Owned Small Business focused on agile, mission-driven results.
Convert raw medical claims (837 EDI, UB-04, CMS-1500) into canonical models applying healthcare coding standards.
Perform data quality audits and write SQL/Spark SQL queries to validate pipeline output and detect overpayment patterns.
Act as SME on claims coding, adjudication rules, and payer policy, mentoring analysts and collaborating with cross-functional teams.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients across the US. Deployed by over 85 health plans and representing more than 270 million lives, the company combines an AI-powered platform with industry expertise to maximize financial outcomes and reduce healthcare costs.
Assigns ICD-10-CM and CPT-4 codes to complex outpatient encounters, including Observation stays and Same Day Surgery.
Reviews medical records thoroughly to ensure accurate diagnosis and procedure codes with at least 95% accuracy.
Resolves NCCI edits, queries physicians for documentation clarification, and utilizes 3M Encoder for coding accuracy.
Northwestern Medicine is a healthcare system focused on providing patient-first care and improving healthcare outcomes. As a large employer, it offers competitive benefits and a culture centered on taking care of its employees.
Code inpatient professional and nursing home services using CPT, ICD-10-CM, and HCPCS.
Apply E/M categories, NCCI edits, and modifiers accurately for surgical and evaluation services.
Maintain 95% accuracy and meet productivity standards while working with clinical documentation.
This partner company provides medical coding and billing services for healthcare facilities, including Veterans Affairs medical centers. It is an equal opportunity employer with a remote team focused on accuracy and compliance.