Perform comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment.
Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides AI tools for government to elevate workforce potential. They have three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.
Negotiate pharmacy agreements across retail, mail, and quality-based channels.
Create and manage network contracting campaigns, analyzing performance metrics.
Work with analytics teams to assess network adequacy and compliance.
Jobgether is a company that uses AI to power the job application process. They ensure applications are reviewed quickly, objectively, and fairly against a role's core requirements.
Conduct warm intake calls, setting expectations and building trust.
Proactively manage patient panels to maximize program completion.
Respond rapidly to cancellations to fill open slots.
Movn Health is a national provider of virtual cardiac rehabilitation and cardiovascular care, partnering with health systems and health plans to deliver accessible, personalized cardiac care. They are a small, mission-driven team where every person has a direct impact on patient outcomes and company success.
Oversee day‑to‑day clinical operations for UM, CM, and DM teams.
Ensure operational workflows meet productivity, quality, and turnaround time expectations.
Partner with the VP of Care Management on operational priorities and process improvements.
Personify Health created the first and only personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. It serves employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes.
Identify, implement, and evaluate information systems and operational processes.
Collaborate with diverse stakeholders to elicit, analyze, communicate, and validate requirements.
Determine resource needs and ensure efficient and effective use of resources to support the EMR.
CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually. CommonSpirit has more than 157,000 employees and contributes more than $4.2 billion annually in charity care.
Lead complex customer implementations and develop clinical workflows.
Build customer relationships to ensure programs meet requirements.
Train and educate customers on product offerings and value proposition.
BioIntelliSense is decoding human physiology and pioneering proactive monitoring to improve healthcare outcomes. They are a remote-first, lean start-up with a global BioTeam that is growth-oriented, collaborative, and passionate about their mission.
Monitors work volume and work distribution to maintain optimal efficiency.
Reviews and reconciles reports and assigned work queues, troubleshooting problem accounts.
Researches coding questions and provides coding training as needed.
Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children, providing a wide range of care and support. As the region's only independent healthcare system dedicated to children, they offer rewarding career opportunities and encourage employees to be their best.
Partner with RCM leadership to monitor performance trends and identify revenue cycle opportunities.
Support payer contracting activities, including onboarding clinical network agreements.
Act as program manager for strategic payer partnership initiatives and drive implementation.
Headspace provides access to lifelong mental health support. They combine content, clinical care, and technology to help millions of members around the world get support. Their culture is collaborative, inclusive, and grounded in their values.
Perform outbound calls to obtain appropriate information and document accurately.
Answer in-bound calls and assist customers with pharmacy related services.
Contact insurance companies for benefit investigation and coverage eligibility.
IQVIA is a global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. They create connections that accelerate the development and commercialization of innovative medical treatments to improve healthcare and patient outcomes.
Codes complex inpatient acute care discharges using ICD-10-CM and ICD-10-PCS codes.
Reviews provider notes and clinical documentation to assign accurate codes.
Collaborates with CDI on discharges, regulatory guidelines, and coding conventions.
Hudson Regional Health is a newly unified healthcare network serving Hudson County through four hospitals. They deliver modern, patient-first care supported by innovation with state-of-the-art procedures and nationally recognized specialists, all within a connected, local network designed to put care first.