Verifies and collects patient demographic and insurance information through direct data entry into the electronic medical record during scheduling, pre-admission, or admission.
Performs insurance benefit verification, documents coverage details, and secures authorizations for surgical procedures and inpatient stays.
Provides financial education to patients regarding insurance liability and explores alternative payer sources or financial assistance options.
NAH is a healthcare organization focused on patient care and services in a clinical setting. It is a structured entity operating with compliance standards and integrated technology across departments.
Accurately abstracts information from service documentation and assigns CPT, ICD-10, and HCPCS codes for billing compliance.
Reviews and resolves coding denials and completes charge sessions in assigned work queues in a timely manner.
Ensures documentation meets current EM Guidelines and specific payer rules before releasing codes for billing.
UofL Health is a fully integrated regional academic health system with hospitals, medical centers, and numerous physician practice locations. It has over 14,000 team members, including physicians and nurses, focused on delivering patient-centered care.
Working on the Market-based Population Health teams and in collaboration with primary care providers, networked partners, and the operations team at Privia Health, the Clinical Quality Associate will provide ownership and execution on defined Value-Based Care program performance metrics
Primary work will include completing quality audits, providing context for provider education, addressing quality gaps in care, payer quality attestations, and regular review and action on local quality performance reports and regional action plans.
The candidate will have relevant experience with project management, educational background or license/certification to support the team
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Review and validate medical codes for accuracy and compliance.
Provide expert coding guidance and support to clinicians.
Conduct coding audits and quality reviews to ensure adherence to regulatory guidelines.
Mission Healthcare is the largest home health and hospice company in the western United States, located in seven states. They provide comprehensive services to meet the needs of patients and families, delivering care with Compassion, Accountability, Respect, Excellence, and Service (CARES).
Directs the coding audit and education operations.
Facilitates training, education, and support to hospital coders.
Provides support to all areas of Management, internal Coding and Billing.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities and advocating for those who are poor and vulnerable.
The Claims Edit Specialist will review and resolve hospital-based claim edits for both inpatient and outpatient services.
Provide specific education on these claim edits to hospital coders through a variety of mediums.
Responsible for facilitating training, education, and support to hospital coders which may be based on detailed analysis of general or coder-specific trends.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services, accessible to nearly one out of every four U.S. residents. They are committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Use knowledge of reimbursement methodologies to analyze, define and maintain hospital payer contracts.
Analyze complex contract provisions and reimbursement rates to identify all necessary terms for accurate system configuration.
Validate system-generated valuations against client-submitted claims and estimates, reconciling discrepancies.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets, from financial services to healthcare, automotive, agrifinance, insurance, and many more industry segments with a team of 23,300 people across 32 countries.
Explain Isaac Health’s services and offerings to interested patients.
Coordinate cognitive health screening campaigns and take medical history.
Schedule and coordinate appointments, assisting patients with technology.
Isaac Health aims to improve brain health at the population level by providing greater access to specialty brain health and dementia care services. Since launching in 2022, Isaac Health has scaled to provide brain health and dementia care services to more patients and families across the US.
Manage the standard credentialing review process for pharmacies.
Review exclusion lists to identify any excluded pharmacies.
Manage the development and maintenance of a credentialing database.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have solutions such as Capital Rx and Judi® which consolidates all claim administration-related workflows in one scalable, secure platform.
Lead and develop a team, setting clear expectations, managing performance directly, and building a team that surfaces problems and drives solutions independently
Own provider quality program and define what quality means at Grow, setting and maintaining the clinical standard across the provider network, and driving measurable improvement in provider quality across the network
Oversee MIC program integrity and VBC performance monitoring by ensuring Grow is on track against payor contract targets, identifying clinical risks early, and partnering with Operations and Product to close gaps
Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care, operating as a three-sided marketplace that empowers providers, augments insurance payors, and serves patients. They have empowered more than ten thousand therapists and hundreds of thousands of clients across the country.