Analyze and audit inpatient claims for DRG validation, coding accuracy, and clinical appropriateness without a medical record.
Utilize proprietary auditing systems to make determinations and generate audit letters, meeting productivity and quality standards.
Identify new claim types and suggest process improvements while maintaining expert ICD-10 and DRG coding knowledge.
Cotiviti is a healthcare analytics and auditing company that helps payers and providers improve financial performance and clinical outcomes. It is a large organization with a culture focused on accuracy, compliance, and collaboration.
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.
Focuses on ensuring accuracy, compliance, and integrity of medical coding across healthcare records.
Conducts detailed audits, reviews clinical documentation, and identifies discrepancies impacting billing and compliance.
Collaborates with clinicians, revenue cycle teams, and leadership to improve documentation quality and coding consistency.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They process applications and share shortlists with employers, focusing on objective and fair review.
Manage insurance verification, authorization processes, and referral coordination to ensure patients receive timely access to covered medical services.
Work closely with insurance providers, clinical documentation, and internal systems to ensure accuracy and compliance across all steps.
Verify active insurance coverage and review patient benefits in detail.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly, objectively, and fairly against core role requirements. The system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.