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Claims Auditor at Cohere Health - ApplyBlast

Claims Auditor

Cohere Health

3 months ago

3.3 on Glassdoor

Remote

Full Time

Senior

0 applicants

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About this role

Cohere Health is seeking a Claims Auditor to join the Payment Integrity team, focusing on comprehensive professional and facility coding reviews for outpatient and inpatient claims. The role involves analyzing code assignment accuracy, determining DRG reimbursement, and identifying potential overpayments using industry-leading tools and expert knowledge. Success in this position requires deep analytical auditing skills, strict adherence to compliance regulations, and expertise in healthcare payment methodologies.

Responsibilities

Conduct comprehensive coding reviews for outpatient and inpatient claims
Analyze code assignment accuracy and determine DRG reimbursement
Identify and maximize potential overpayment recoveries using industry tools
Craft clear audit findings backed by AHA Coding Clinic Guidelines
Stay ahead of industry trends and compliance regulations

Skills

Qualifications

Bachelor's DegreeCPC CredentialCCS Credential

About Cohere Health

coherehealth.com

Headquarters

Boston, Massachusetts, United States

Company Size

501-1000 employees

Founded

2019

View Profile

Cohere Health is a healthcare technology company offering an AI-powered clinical intelligence platform, Cohere Unify, that connects utilization management, prior authorization, payment integrity, appeals, care management, quality, and claims operations for health plans. By combining domain-specific AI with human clinical expertise, Cohere streamlines authorization workflows, reduces unnecessary costs, and improves patient access to appropriate care. The company serves health plans and provider organizations, delivering measurable outcomes including real-time prior authorization approvals, payment audit efficiency, and HEDIS quality gap closure.