Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
Cohere Health provides an AI-powered clinical intelligence platform that streamlines access to quality care by improving payer-provider collaboration and cost containment. The company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 and 2024.
Lead a remote team of outpatient coding auditors to identify overpayment opportunities and deliver accurate audit outcomes.
Oversee audit operations, ensuring consistency in APC/APG grouping, OPPS packaging, and outpatient coding policy application.
Manage team performance, productivity, and quality while providing coaching and professional development.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans and representing more than 270 million lives, the company fosters a culture of innovation and disruption.
Serve as an expert in coding guidelines and perform audits to ensure compliance.
Develop and deliver role-specific training and educational materials for coding staff.
Analyze billing/coding behavior and recommend improvements.
UW Medicine is Washington’s only health system with a top-rated medical school and an internationally recognized research center. Nearly 29,000 healthcare professionals, researchers, and educators work within its family of organizations.
Manages a remote team of behavioral health coding auditors, ensuring audit quality and team performance.
Serves as subject matter expert in behavioral health CPT coding, DSM-5 diagnostic coding, and payer requirements.
Drives operational strategy including capacity planning, staffing, and quality standards for behavioral health audit operations.
Machinify is a leading healthcare intelligence company delivering value and efficiency to health plan clients. Deployed by over 85 health plans, including many of the top 20, and representing over 270 million lives, they offer a flexible and trusting remote work environment.
Review medical records within 24-48 hours of admission to evaluate documentation for accurate DRG assignment, severity of illness, and risk of mortality.
Conduct follow-up reviews every 2-3 days and formulate compliant provider queries regarding missing or conflicting documentation.
Educate patient care team members on documentation guidelines and collaborate with HIM coding professionals to ensure accuracy and integrity.
CommonSpirit Health is a large nonprofit Catholic healthcare organization delivering integrated health services. It has over 157,000 employees and 45,000 nurses across 24 states.
Perform medical necessity reviews of clinical documentation to determine appropriateness of inpatient and outpatient services.
Develop relationships with medical providers and health plans to confirm adherence to policies and guidelines.
Stay updated on technology changes, regulatory issues, and medical practices through ongoing training.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve healthcare access. It promotes a collaborative and innovative work environment as a dynamic, growing organization.
Oversees a team of Clinical Validation Auditors to ensure productivity and quality standards are met.
Manages queue distribution, performance optimization, and training for new hires and existing staff.
Collaborates with Auditors and Quality Assurance to produce high-quality recoverable claims and meet client SLAs.
Cotiviti provides healthcare auditing and analytics solutions to help clients recover overpayments and improve compliance. The company fosters a collaborative and team-oriented culture with a focus on quality and employee development.
Auditing claims for medically appropriate services in inpatient and outpatient settings using medical review guidelines.
Documenting findings with reference to appropriate policies and rules.
Generating letters articulating audit findings.
Machinify is a healthcare intelligence company delivering value and efficiency to health plan clients across the US. Deployed by over 85 health plans representing over 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare cost reduction.
Conduct training and education on risk adjustment documentation and coding guidelines for providers.
Perform comprehensive medical record chart audits to validate ICD-10-CM coding and HCC assignments.
Analyze claims data and audit error rates to identify trends and recapture opportunities for chronic conditions.
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, with scalable operations and cloud-based technology.
Provides onsite and remote clinical documentation integrity support to CDI programs as part of the System Office CDI Float Pool.
Reviews and audits medical records to ensure accurate documentation of medical necessity, severity of illness, and level of services.
Trains end users on CDI software systems and communicates with healthcare teams to improve documentation practices.
Trinity Health is a large not-for-profit, faith-based health care system with 121,000 colleagues and nearly 36,500 physicians and clinicians serving communities across 27 states. The system includes 101 hospitals and invests heavily in community benefit programs.
Oversee inpatient coding teams to ensure adherence to enterprise KPIs and compliance standards.
Act as liaison between CDI, physicians, and other departments to maintain accuracy of medical records.
Monitor daily DNFC and coding work queues, developing action plans for sustained improvements.
CommonSpirit Health is a nonprofit Catholic healthcare organization providing integrated health services. With over 157,000 employees and 45,000 nurses, it operates across 24 states, delivering more than 20 million patient encounters annually.