Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Conduct complex medical review of Medicare claims for Inpatient Rehabilitation Facility services.
Perform pre-claim review determinations and evaluate Additional Documentation Request responses.
Communicate determinations to providers and meet production-driven turnaround requirements.
Broadway Ventures is a small business that provides program management, technology, and consulting solutions to government and private sector clients. As a Service-Disabled Veteran-Owned Small Business, they emphasize integrity, collaboration, and excellence.
Review prior authorization cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
Review OASIS documentation and plan of care to ensure compliance with regulations and accuracy.
Evaluate patient visit frequency and utilization to align with clinical needs and provider orders.
Collaborate with coding partners and escalate documentation improvement opportunities to leadership.
Graham Healthcare Group designs business and technology solutions to drive better care and outcomes in home health and hospice. As a subsidiary of a publicly traded company, they've been improving care coordination for over 20 years, focusing on patient-centered home care.
Perform clinical medical record review and abstraction to support healthcare quality and compliance.
Apply established review criteria consistently and document findings clearly and objectively.
Work independently to complete accurate reviews within project deadlines while managing multiple priorities.
Health Services Advisory Group (HSAG) is transforming the delivery of healthcare in the United States. They are a growing team dedicated to improving healthcare quality, with a focus on community and collaboration.
Apply certified coding expertise to healthcare coding activities while maintaining high accuracy and quality.
Review and interpret clinical and administrative documentation to support appropriate coding outcomes.
Follow established coding standards, policies, and regulatory requirements while protecting data confidentiality.
A partner company in the healthcare coding industry seeks a certified coding professional. The full-time remote role supports accurate and compliant coding operations in a structured environment.
Review and analyze medical record documentation to assign diagnoses and procedure codes for inpatient, outpatient, and professional services.
Ensure compliance with official coding guidelines and ethical standards set by AHIMA.
Work remotely in a full-time, days shift position using ICD-10-CM and CPT/HCPCS coding systems.
Mercy is a Catholic health system founded by the Sisters of Mercy, providing care across hospitals and clinics in the Midwest. It is a large, collaborative organization focused on innovation, technology, and compassion, with a heritage spanning over 195 years.
Conduct facility inpatient coding audits using MS-DRG and APR-DRG methodologies, providing evidence-based recommendations.
Identify coding quality and compliance opportunities while delivering coder education through the audit process.
Manage multiple cases concurrently, maintain accuracy, and uphold professional ethics and confidentiality.
Our partner provides healthcare organizations with high-quality, compliant coding practices through inpatient coding audits. They offer a collaborative, service-oriented environment focused on coding excellence and continuous professional development.
Conduct clinical audits for suspected fraud, waste, and abuse with high autonomy.
Document findings in formal reports, graphs, and audit logs, aligning with unit goals.
Develop and present FWA-related education to Oscar teams, ensuring compliance with regulations.
Oscar is a health insurance company built on a full stack technology platform, focused on serving members like a doctor in the family. Founded in 2012, it is a forward-thinking company that values diversity and innovation, with a culture of fostering belonging and support.
Review and analyze complete patient medical records to identify all diagnostic and procedural information.\n- Assign accurate diagnostic and procedural codes using encoder software to ensure proper MS-DRG assignment and sequencing.\n- Maintain compliance with coding guidelines and verify medical record completeness for accurate reimbursement.
Henry Ford Health is a leading academic health system providing a comprehensive continuum of care, including primary to complex care, virtual care, and health insurance. With 12 hospitals and hundreds of ambulatory locations across Michigan, it is headquartered in Detroit and committed to innovation and community impact.
Conducts appeals reviews of new evidence disputing medical review audit findings.
Documents and reports appeals results accurately, upholding or overturning determinations.
Serves as a subject matter expert, supporting training and process improvements.
Machinify is a healthcare intelligence company offering an AI-powered platform for health plan payment and clinical review. It serves over 85 health plans and over 270 million lives, with a culture of innovation and continuous improvement.
Review and abstract professional medical records and assign accurate ICD-10-CM, CPT, and HCPCS codes.
Maintain coding quality metrics, participate in audits, and stay current with coding guidelines.
Ensure confidentiality and adhere to HIPAA and compliance standards while working independently.
Sprinter Health reimagines how people access care by bringing it directly into their homes, using technology to deliver care where people are. Backed by over $125M from top investors like a16z, General Catalyst, GV, and Accel, the team of clinicians, technologists, and operators has supported 2 million patients across 22 states with a 92 NPS.
Review patient information and medical histories to provide online patient care and education.
Participate in patient visits and answer questions through our telehealth platforms.
Follow established protocols and collaborate with the healthcare team, all conducted 100% remotely.
Florida Telehealth Medical Group is an innovative telemedicine company currently operating in 49 states. We treat tens of thousands of patients every month and are growing rapidly.
Perform medical necessity and level of care reviews using clinical judgment and guidelines.
Obtain member information via telephone and fax to assess condition and apply evidence-based criteria.
Meet decision-making SLAs and refer members for further care engagement when needed.
Oscar Health is a technology-driven health insurance company focused on simplifying healthcare for its members. We are a mission-driven organization with a diverse team, committed to innovation and equity in healthcare.
Process and maintain accurate Medicare enrollment and disenrollment requests, ensuring compliance with CMS regulations.
Reconcile membership reports and resolve enrollment system rejections, building case files for CMS approval.
Mentor junior team members and collaborate on special projects, including process documentation and quality reviews.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, aiming to modernize operations and improve competitiveness. UST HealthProof, a fast-growing company, focuses on reducing administrative costs and improving healthcare experiences, led by seasoned leaders fostering a supportive, growth-oriented environment.
Review outpatient medical records and assign diagnosis and procedure codes accurately based on clinical documentation.
Maintain a minimum 95% coding accuracy rate and meet productivity expectations while handling complex coding scenarios.
Collaborate with stakeholders to identify documentation improvement opportunities and ensure compliance with coding standards.
The company provides healthcare coding consulting services to hospitals and clinics. It is a remote-first organization that values accuracy, quality, and professional development, with a collaborative and supportive culture.
Must hold AHIMA or AAPC certification (CPC, CIC, COC) with at least two years of recent inpatient coding in acute care.
Requires proficiency in ICD-10-CM and ICD-10-PCS coding, MS DRG classification, and remote connectivity tools.
Must meet productivity targets and maintain coding quality of 95% or greater.
UASI is a coding and HIM services provider with over 40 years of experience, offering remote work opportunities for healthcare professionals. They have been recognized as a Top Workplace by the Cincinnati Enquirer for five consecutive years and value long-term employee stability and growth.
Complete final review of medical records and select appropriate ICD-10 and CPT codes within 4 days of patient discharge.
Review documentation to match codes with medical necessity and assign working diagnoses and DRGs.
Collaborate with Clinical Documentation Specialists to identify and address documentation deficiencies.
UAMS is Arkansas' only comprehensive academic health sciences center, combining education, research, and clinical programs. It fosters a collaborative culture focused on improving patient care and supporting teamwork and diversity.
Manage a team delivering outsourced coding services to critical access hospitals and rural health clinics.
Ensure accurate and timely coding of medical records, compliance with ICD-10, CPT, and HCPCS guidelines.
Implement quality assurance audits, resolve coding discrepancies, and collaborate with providers and billing departments.
Tegria helps healthcare organizations improve care, technology, revenue, and operations, moving from patient-centered to human-centered. They have a diverse team of talented people who welcome challenge and change, fostering a culture of equity and inclusion.
Conduct routine and focused audits of medical coding to ensure compliance with CMS, payer, and organizational standards.
Develop and deliver education and feedback to coders and providers to improve documentation quality and coding accuracy.
Assist with internal and external audit preparation and response, including documentation requests and validation reviews.
Sprinter Health reimagines healthcare by delivering care directly to patients' homes using marketplace and last-mile technologies. They have supported over 2 million patients across 22 states, completed 130,000 in-home visits, and raised over $125M from investors like a16z and General Catalyst, with a team of clinicians, technologists, and operators.