Investigate and resolve insurance claim denials, handling 50 to 100 denials daily with speed and accuracy.
Partner with payers to secure timely reimbursement and interpret LCD/NCD requirements for CPT/HCPCS-related denials.
Provide top-tier phone support to patients, insurance companies, and internal teams while using payer portals and clearinghouses.
IVX Health is a national provider of infusion and injection therapy for individuals managing complex chronic conditions like rheumatoid arthritis, Crohn’s disease, and multiple sclerosis. We foster a culture of respect, empowerment, and shared purpose, with a team committed to patient-centered outcomes and values such as Be Kind and Do What’s Right.
Resolve aged claims and appeals via payer portals & outbound phone calls.
Identify non-payment trends and escalate groups of claims to the Dispute Resolution teams.
Propose solutions and collaborate cross-functionally with the Denials Management Steering Committee.
CareDx, Inc. is a precision medicine solutions company focused on healthcare solutions for transplant patients. They offer products, testing services, and digital healthcare solutions. They are the leading provider of genomics-based information for transplant patients.
Analyze denied insurance claims and apply clinical reasoning to determine appeal merit.
Draft persuasive, medically sound appeal letters to recover denied revenue.
Collaborate with legal team to ensure appeals are compelling and complete.
Ternium specializes in resolving complex healthcare insurance claim denials and delays for hospitals. They have a dedicated, mission-driven team and value diversity and inclusion.
Manages medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Utilizes clinical background to address the clinical denials, as well as write sound, compelling factual arguments for appealing denials.
Responsible for maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria, as well as filing compliant appeals.
Shriners Children’s respects, supports, and values each other. They are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact and were named as the 2025 best mid-sized employer by Forbes.
Analyze "trigger reports" to identify potential financial exposure early in the claims process.
Gather clinical information to evaluate liability and make recommendations to stakeholders.
Provide cost containment by managing Stop Loss claims and negotiating prices for medical services.
Ullico is the only labor-owned insurance and investment company and has been a partner of the labor movement for over 95 years. The company provides insurance products for members, leaders, and employers, as well as investments.
Own the full AR cycle: payment posting, cash reconciliation, aging management, and payer follow-up across district, health plan, and member inquiries.
Investigate and resolve complex claim denials and rejections, submit corrected claims and appeals, and drive systemic fixes to improve clean claim rates.
Serve as internal subject matter expert on payer requirements, billing regulations, and compliance standards, fielding escalations from clinical and operations teams.
Cartwheel is building a new kind of mental health program for kids that puts schools at the center. Backed by top investors, it has grown to serve more than fifty school districts across six states and is driven by a mission to help millions of students experience joy.