Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues.
Proactively identify overpayments to ensure accurate claims payments on inpatient services.
Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.
They are reinventing health insurance by combining data with human empathy to keep members healthier. Clover Health believes the healthcare system is broken, so they've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most. They are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
Work in a partially remote environment, collaborating with team members virtually each day.
Serve as a Subject Matter Expert (SME) on quality improvement measures, customer needs, and payer‑specific quality initiatives across commercial and government programs.
Conduct proactive patient outreach to identify and close quality gaps—educating patients, scheduling screenings, supporting treatment plan adherence, and improving outcomes.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Develop and implement outreach strategies to prevent or manage cardiovascular disease, hypertension, and stroke.
Perform needs assessments in selected rural areas/counties.
The American Heart Association (AHA) is dedicated to fighting heart disease and stroke. AHA is a non-profit, voluntary health organization offering hands-on experience for students interested in gaining work experience.
Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.