Source Job

• Investigate and resolve health plan denials for coding-related issues, including rejections, down codes, bundling, modifiers, and level of service.
• Generate appeals based on dispute reasons and contract terms specific to payors, including online reconsiderations and following payer guidelines.
• Maintain working knowledge of workflows, systems, and tools used in the department, adhering to production and quality standards.

Ventra is a leading business solutions provider for facility-based physicians, focusing on Revenue Cycle Management. The company partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver data-driven solutions.

• Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
• Review provider documentation and assign accurate codes per ICD-10-CM, CPT, and HEDIS/quality reporting guidelines.
• Maintain and contribute to the internal billing rules matrix (payer, state, provider type, modifiers).

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that reimagines care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care. They enhance existing care teams with compassion, creativity, and an unwavering commitment to children with medical complexity.

• Assist team on a smooth end-to-end billing process
• Investigate, document, and follow up on denials and underpayments
• Complete recurring work queues on a monthly basis

Omada Health is reverse engineering healthcare delivery, focusing on the space between doctor visits. They offer virtual-first models with human-led care teams, connected devices, and AI to support chronic conditions and have served over two million members across 2,000+ organizations.

• Maintains practice management systems, processes insurance claims, and reconciles patient accounts.
• Investigates rejected claims, corrects denials, and facilitates payment through collections and billing reminders.
• Ensures HIPAA compliance, resolves patient billing issues, and provides professional customer service.

US Anesthesia Partners provides anesthesia services and revenue cycle management. It is a large US-based healthcare organization focused on billing and insurance operations, emphasizing accuracy and compliance.

• Lead client onboarding and coding integration programs, ensuring smooth transitions and long-term operational success.
• Oversee outpatient and physician coding operations, ensuring accuracy, compliance, and productivity.
• Partner with teams to align coding practices with revenue cycle objectives and drive performance improvements.

Jobgether uses AI-powered matching to connect candidates with hiring companies. They focus on efficient, objective candidate evaluation and data privacy compliance.

• 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.

Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota. We are motivated by the well-being of our members, not profits, and we are committed to sustainability and innovation.

• 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.

• Process timely and accurate billing of medical claims in multiple states.
• Monitor accounts daily to maximize reimbursement and identify potential billing compliance issues.
• Utilize EHR and billing systems to manage claims, denials, and payer communications.

Indigenous Pact PBC, Inc. is a certified B-Corporation established in 2017 with a mission to create health equity for American Indians and Alaskan Natives. The dedicated team has decades of experience working in Indian Country, specializing in customized solutions for sustainable revenue and improved health outcomes.

• 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.

• 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.

• Interpret medical rules, regulations, fee schedules, and edits that payers post.
• Understand and manipulate payer data to build federal, state, and commercial coding and financial tables.
• Maximize the efficiency and use of product solutions by properly maintaining payer specific edits.

Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets and have an amazing team of 25,200 people in 32 countries.

• Conduct research and quality assurance for drug and biological policies.
• Write business logic and translate industry references into Cotiviti policy.
• Mentor new team members and assist with customer inquiries regarding clinical rules.

Cotiviti is a healthcare analytics company that provides clinical coding and policy solutions for health plans. They focus on maintaining accurate medical policy libraries and employ a global team, offering benefits like PTO and paid family leave.

• Evaluate and present audit results and educational instruction to physicians, coders, and staff.
• Review clinical documentation to ensure adherence to billing guidelines and internal coding policies.
• Provide instruction on documentation standards and correct use of CPT‑4 and ICD‑10 codes.

Pediatrix Medical Group is a leading provider of specialized healthcare for women, babies, and children. Since 1979, they've grown into a national, multispecialty medical group with a commitment to coordinated and compassionate care, bolstered by investments in research, education, and safety.

• Perform inpatient coding audits and review services remotely.
• Identify trends and suggest corrective action plans.
• Provide in-service education to clients on coding trends.

UASI has over 40 years of experience and enduring partnerships with its valued clients. The company was recognized as a Top Workplace by the Cincinnati Enquirer in 2022, 2023 and 2024, with a dedicated team and long-term success.

• Improve first-pass claim acceptance by ensuring correct coding, flagging inconsistencies, and reviewing EOBs and denial trends to identify recurring issues.
• Work closely with billing teams and vendors to resolve complex claim issues, review clinical documentation, and support coding corrections and resubmissions.
• Ensure compliance with CMS, state Medicaid, and managed-care guidelines while monitoring payer policy changes to optimize coding and billing practices.

ReKlame Health is a clinician-led, tech-enabled provider group providing culturally competent behavioral health and addiction care. As an early-stage organization focused on expanding access to care and health equity, they are building a purpose-driven team dedicated to making a positive impact.

• 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.

• Analyze and investigate practitioner information using health information systems to distribute credentialing and enrollment packets.
• Prepare and distribute data for state, federal, and commercial carriers, ensuring compliance with legal and regulatory requirements.
• Collaborate with internal departments and partners to achieve accurate credentialing, timely enrollment, and compliant billing status.

OHSU is Oregon's only public academic health center, combining patient care with groundbreaking research and training the next generation of healthcare professionals. As Portland's largest employer, OHSU offers opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington, fostering an inclusive, anti-racist multicultural institution.

• Lead advanced coding education for providers and groups, including E/M and Medicare Preventive services.
• Analyze coding performance indicators to identify training needs and improve accuracy.
• Develop and refine coding presentations and materials reflecting latest industry standards.

Privia Health is a technology-driven, national physician enablement company that optimizes physician practices and improves patient experiences. The company is led by top industry talent and physician leadership, with scalable operations and cloud-based technology.

• Prepare, review, and submit Medicare Part A & B claims for skilled nursing residents.
• Ensure timely and accurate billing in accordance with CMS and SNF-specific guidelines.
• Track, appeal, and resolve denied or rejected claims efficiently.

Tutera Senior Living & Health Care is dedicated to providing senior living and healthcare services guided by the YOUNITE philosophy. The company is family-owned, founded in 1985, and offers stability, competitive wages, and benefits, with a focus on developing employees through Tutera University.

• 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.