Complete credentialing and re-credentialing applications for physicians, ancillary providers, and facilities with third-party payers and government programs.
Perform primary source verification services including license, malpractice, and work history verification.
Maintain CAQH profiles and credentialing databases, partner with client liaisons, and follow up with payers on submitted applications.
BerryDunn is a client-centered, people-first professional services firm providing tax, advisory, and consulting services since 1974. The firm is led by CEO Sarah Belliveau and is recognized for its diverse and inclusive workplace culture and focus on learning, development, and well-being.
Conduct online research and consumer insights analysis to support healthy living program development.
Create promotional materials and edit content for diverse audiences including multicultural outreach.
Provide administrative support for meetings, slide decks, and stakeholder coordination.
The American Heart Association is a nonprofit voluntary health organization dedicated to fighting heart disease, stroke, and other cardiovascular diseases. With over 100 years of trusted leadership, the organization employs thousands and fosters a culture of work-life harmonization and professional development through resources like Heart U.
Must have at least 5 years' RN experience with current licensure, a bachelor's degree or equivalent, and at least 1 year of leadership with direct reports.
Responsible for overseeing RN denials management specialists, pre-bill utilization reviews, payer calls, workflow optimization, and collaboration with internal RCM teams.
Blends clinical expertise with revenue cycle management to protect the organization's bottom line, decrease A/R, and ensure compliance.
Banner Health is one of the largest nonprofit health care systems in the country, providing hospital services, primary care, research, and physician practices across multiple states. With 31 facilities and a focus on innovation, they recently earned Great Place To Work certification, reflecting their investment in employee happiness and fulfillment.
Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
Cohere Health provides an AI-powered clinical intelligence platform that streamlines access to quality care by improving payer-provider collaboration and cost containment. The company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 and 2024.
Review medical records and clinical documentation to ensure accurate, compliant coding per CMS, federal, state, and payer policies.
Conduct routine and focused coding audits, collaborate with clinical leadership and revenue cycle teams, and provide actionable recommendations.
Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, interpreting state-specific billing requirements.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual and in-home medical, behavioral, and social care, and are a remote-first, high-growth environment.
Lead Omada's Clinical Quality department with end-to-end accountability for program integrity, performance, and continuous improvement across cardiometabolic programs.
Define and drive the near-term roadmap for program quality, accreditation readiness, quality analytics, and AI bias monitoring.
Build durable quality infrastructure that supports a growing portfolio of clinical products and care experiences, partnering across teams.
Omada Health is a virtual-first healthcare company on a mission to bend the curve of chronic disease by combining human-led care teams, connected devices, and AI-enabled technology. The company has served over two million members across 2,000+ employers and health plans, and fosters a culture of trust, context, boldness, and collaboration.