Provide clinical leadership and subject-matter expertise to support analysis and configuration of medical policy content within claims processing systems.
Ensure accurate implementation of medical policies, review criteria, and authorization requirements while maintaining system infrastructure integrity.
Serve as an expert resource for medical policy configuration and PGE coding, mentoring Coding Specialists and providing training to operational partners.
Perform accurate code assignments for ED records (facility and profee) while working remotely.
Be flexible, detail-oriented and have the ability to work independently.
Meet client productivity targets while maintaining coding quality of 95% or greater.
UASI is a company that values its employees! They have been awarded the Top Workplace award by the Cincinnati Enquirer in 2022 and 2023. Their 40 years in business contributes to the long tenure of their team.
Conduct coding audits to ensure accuracy and compliance with coding guidelines.
Identify compliance risks and recommend corrective action plans.
Provide education and training to physicians and staff on coding best practices.
Theoria Medical is at the forefront of healthcare innovation and quality, offering a blend of medical excellence and technological advancements, primarily serving the post-acute sector. Their network includes multispecialty physician services across skilled nursing facilities nationwide, fostering a mission-driven culture that values expertise and innovation.
Identifies and applies appropriate ICD-10 and CPT codes.
Ensures accurate entry of insurance benefits and authorizations.
Completes other activities to ensure complete and accurate claims.
Sarasota Memorial Healthcare System is committed to keeping people safe. They require all individuals providing care to vulnerable populations to undergo background screening.
Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Accountable to meet and maintain established department production and quality standards.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards.
Ensure claims are processed correctly and on time through clear communication and efficient management of records.
Dignity Health Medical Foundation provides comprehensive health care services. They have care centers throughout California and are affiliated with Dignity Health, one of the largest health systems in the nation. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.
Support medical policy functions by providing medical coding and system configuration support.
Perform coding analyses and utilization reporting to recommend medical policy updates.
Participate in cross-functional meetings to align with enterprise strategic priorities.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. Motivated by the well-being of members, they are committed to service, sustainability and innovation.
Focuses on ensuring accuracy, compliance, and integrity of medical coding across healthcare records.
Conducts detailed audits, reviews clinical documentation, and identifies discrepancies impacting billing and compliance.
Collaborates with clinicians, revenue cycle teams, and leadership to improve documentation quality and coding consistency.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They process applications and share shortlists with employers, focusing on objective and fair review.
Perform daily audits on provider appeals for completeness and accuracy based on specified coding guidelines.
Stay current on coding guidelines appropriate to the position; learn new appeal categories as production needs require.
Professionally communicate finds, errors, and suggestions to facilitate on-going communications and efficient department operations.
Cotiviti focuses on claims audits for appeals, checking for completeness & accuracy based on coding guidelines. They offer a team-oriented environment and a comprehensive benefits package to address various personal and family needs.
Support the design and implementation of clinical protocols and medical policies.
Analyze medical records to ensure accurate code assignments and maintain compliance.
Evaluate treatment plans and prior authorizations while auditing large claims.
Gravie's mission is to create health benefits that actually benefit small and midsize businesses and their employees. They are a non-hierarchical, merit-driven company of opinionated but kind people who thrive in a high-performance, fast-paced environment.
Coordinate medical record retrieval, ensuring complete and timely submission of patient documentation for provider review
Prepare and process referrals to specialists and manage prior authorization requests in coordination with insurance payors
Virtually greet and room patients prior to telehealth appointments, confirming patient information and visit readiness
Synapticure is a patient and caregiver-founded company that provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. They are dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and ALS.
Monitor and interpret CMS guidance for Medicare, Medicaid, and other healthcare programs.
Partner with internal teams to ensure compliance with regulations and contract obligations.
Maintain regulatory tracking documentation and support development of training materials.
HealthEdge provides healthcare software and services to payers and providers. It is a growing company with a focus on compliance and innovation, fostering a collaborative and remote-friendly culture.
Verify insurance eligibility and benefits for all new Boulder Care commercial enrollments.
Answer incoming questions from patients about balances due and non-covered charges.
Serve as subject matter expert for internal insurance training and identify billing errors.
Boulder Care is an award-winning digital clinic for addiction medicine, recognized for innovation and high quality of patient care. Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work.
Audit behavioral health documentation and coding (ICD-10-CM and CPT) for accuracy, compliance, and completeness.
Deliver actionable feedback to providers, educating on coding and documentation guidelines.
Serve as a subject matter expert by answering coding-related questions and supporting internal teams.
Headway is building a new mental healthcare system from the ground up—one that’s accessible, effective, and built to scale. They have over 75,000 providers across all 50 states running their practice on their software, serving over 1 million patients.
Interpret health record documentation using ICD-10 and CPT 4 coding systems for diagnoses and procedures.
Assign and sequence codes accurately, reconcile edits, and maintain 95% coding quality.
Act as a key liaison for physicians on coding compliance and documentation improvement.
Shriners Children’s is an organization that provides excellence in pediatric specialty care, multi-disciplinary education, and research with global impact. Named the 2025 best mid-sized employer by Forbes, they foster a learning environment that values evidence-based practice and critical thinking.