Assess physician educational needs regarding coding and documentation, and develop training programs.
Conduct coding and billing training for billing specialists and physicians.
Perform coding and data quality reviews to ensure compliance with standards and regulations.
Piedmont Healthcare is a healthcare organization focused on providing comprehensive medical services. They offer wellness programs and benefits, fostering a supportive culture for employee growth and recognition.
Perform clinical validation and medical record abstraction to ensure accuracy and compliance with CMS quality measures.
Identify and resolve data discrepancies in collaboration with internal teams and external vendors like Oracle Health.
Support timely regulatory submissions and cross-train across validation and abstraction functions for workload flexibility.
Banner Health is a large, nonprofit health care system in the US, providing hospital services, primary care, and research across multiple communities. With a network of hospitals and clinics, they employ skilled professionals using advanced technology to improve patient care.
Provide clinical and operational leadership to support timely, evidence-based coverage determinations in Utilization Management.
Coach reviewers on consistent application of medical-necessity criteria, medical policy, and benefit plan language.
Monitor daily workflow health, coordinate coverage plans, and communicate barriers and risks to the UM Manager.
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. The company serves employers, health plans, and health systems with data-driven solutions and is on a mission to empower people to lead healthier lives.
Responsible for initiating ERA and EFT setup with clearinghouses and payers.
Assist in vendor support for daily cash reconciliation and understand RCM Payment Posting Processing.
Maintain payer portal admin and employee registration; resolve unidentified payments.
Advantia Health provides unparalleled healthcare services to customers. The company employs highly qualified individuals and is an equal opportunity employer committed to diversity.
Investigate and resolve denied, underpaid, or aging insurance claims using payer portals and billing systems.
Submit timely appeals and manage aging reports to reduce revenue delays.
Collaborate with billing, coding, and operational teams to resolve claim issues and maintain accuracy.
Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. With over 70 clinics across 8 states and a Net Promoter Score of 93, we deliver compassionate, results-driven care in a modern, patient-first environment.
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.
Lead deep-dive analyses of clinical and technical denials to uncover root causes affecting hospital reimbursement and operational efficiency.
Partner with hospital leadership and revenue cycle teams to present findings and support operational transformation initiatives.
Design and deliver training and documentation to improve denial prevention practices across teams and departments.
Our partner is a healthcare services organization operating in revenue cycle management and analytics. It is a growing company with strong client relationships and a focus on operational transformation.
Provides remote RN approvals and support for field users, responding to requests via phone, fax, and email.
Manages workflow tasks such as data entry, eligibility, scheduling, and POC approvals within 30 minutes.
Monitors communication systems, prioritizes tasks by patient needs, and escalates unresolved issues to management.
Moments Hospice is a leading hospice organization dedicated to personalizing end-of-life care and treating patients, families, and team members like family. The company fosters a supportive community and workplace culture where employees are proud to be part of the Moments family.
Provide medical coding, system configuration, and administrative support for medical policy functions.
Perform coding analyses and utilization reporting to recommend updates to medical policies and system configuration.
Participate in cross-functional meetings to align with enterprise strategic priorities and support team operations.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. We prioritize member well-being over profits, with a focus on sustainability and innovation.