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.
Support quality assurance and audit planning for the WTC Health Program
Analyze claims data to identify trends and recommend improvements
Maintain health plan codebook and ensure accurate medical coding standards
Advanced Technologies & Laboratories International, Inc. (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. The company offers a competitive total compensation package and invests in professional growth through tuition reimbursement and certification programs.
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.
Perform daily audits on client data for completeness and accuracy of coding using clinical knowledge.
Respond to provider appeals and meet client turnaround time and KPI goals.
Utilize coding validation training to become familiar with claims payment policies and regulations.
Cotiviti is a healthcare analytics company that uses data-driven solutions to improve payment accuracy and quality in healthcare. The company offers a competitive benefits package and fosters a collaborative, fast-paced work environment.
Perform complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules.
Collaborate with operations consultants, RCM AR staff, and management to address Care Center payment performance audits and maximize cash flow.
Identify, monitor, and manage denial management trends, and work closely with Revenue Cycle Teams and payer representatives.
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, focusing on reducing healthcare costs and improving outcomes.
Perform advanced healthcare payment audits by analyzing claims data and identifying discrepancies.
Develop and improve audit concepts focused on payment accuracy and reimbursement policies.
Collaborate with audit, engineering, and business teams to ensure accurate findings and process improvements.
Jobgether is an AI-powered job matching platform that uses technology to connect candidates with roles. The company operates remotely and focuses on efficient, objective hiring processes.
Own the program's analytics pipeline including claims records, eligibility files, and MAO-004 reconciliation across all clients.
Lead care-gap identification and closure reconciliation, ensuring accuracy for billing and client audits.
Deliver practice-level performance analysis and build funnel instrumentation to identify value leakage.
Covera Health combines clinical expertise, advanced AI, and radiology quality data to improve diagnostic accuracy. Backed by Insight Partners, the company supports nearly 6 million people across major employers and health plans, with a culture focused on meaningful work and saving lives.
Develop and maintain system pricing for health care claims.
Analyze contract financial performance and coordinate internal/external audits.
Provide routine and ad hoc reporting to support business decisions.
HCSC is a health insurance company dedicated to expanding access to high-quality, cost-effective health care. With over 80 years of experience, they foster a collaborative and inclusive culture that values employee development and diversity.
Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Apply CMS guidance, coding guidelines, and industry standards during claim review, including hospital bill audits and itemized bill reviews.
Prepare appeal responses using applicable coding guidance and maintain required certifications and continuing education.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve access to healthcare. They are a dynamic growing organization promoting a collaborative and innovative work environment.
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.
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.