Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
Identify and document systemic payer issues and trends affecting reimbursement.
TREND Health Partners is a tech-enabled payment integrity company. They facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment.
Source, interpret, and scope new payment integrity policies.
Prioritize policy updates based on savings potential and client impact.
Quantify and communicate policy value through data-driven analysis.
Rialtic, Inc. focuses on healthcare payment expertise, client strategy, and product innovation. They seem to have a culture that values collaboration and impact, although the job post doesn't specify size/employees.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Responsible for daily accounts receivable collections and billing. Assist with increasing collections, reducing accounts receivable days, and reducing bad debt. Partners with the field to ensure appropriate and timely revenue and collections.
Execute data analysis of trends and strategic opportunities for quality improvement across Aledade’s value based care portfolio.
Track key performance indicators (KPIs) relating to risk, quality, and affordability for all health plan payer contracts.
Support ad-hoc reporting and data analysis requests for field teams specifically relating to MSSP.
Aledade empowers independent primary care practices to succeed in value-based care. Founded in 2014, they've become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Process transactions on insurance accounts and interact with insurance companies.
Communicate with staff and third-party customers to ensure accurate processing.
Prioritize accounts to maximize aged AR resolution, and research documentation.
Oregon Health & Science University values a diverse and culturally competent workforce. They are proud of their commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Oversee operational and clinical performance of contracted provider partners.
Drive execution on economic, clinical, and population health strategies.
Proactively analyze population health data to identify opportunities for improvement.
Apree Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. They seem to have a fast-paced evolving environment.
Serve as a strategic partner to clients, driving adoption and return on investment.
Manage a portfolio of clients with a focus on Payer Contracts, Claims and Claim Scrubber products.
Evaluate client use of product suite, recommend best practices and configuration improvements.
Experian is a global data and technology company that powers opportunities for people and businesses around the world. They have a team of 23,300 people across 32 countries and corporate headquarters in Dublin, Ireland.
Own the operational infrastructure, continuously improving all workforce systems and quality standards.
Implement and maintain scheduling systems to ensure optimal coverage across all support channels.
Drive the creation and maintenance of support documentation, knowledge bases, and standard operating procedures.
CopilotIQ + Biofourmis is transforming in-home care with the industry's first AI-driven platform that supports individuals through every stage of their health journey. They are helping people live healthier, longer lives by bringing personalized, proactive care directly into their homes.
Maintain day-to-day data quality in the CRM, including account/contact hygiene, opportunity stages, close dates, and activity logs.
Build and manage data validation rules, workflows, picklists, and field definitions to standardize CRM inputs.
Create and maintain dashboards and reports for pipeline, forecast, activity, and account health; ensure data is ready for executive meetings.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against core requirements. Their system identifies the top-fitting candidates to share directly with the hiring company.
Provide support across our full customer base via various channels, addressing complex product and technical inquiries with accuracy and efficiency.
Guide customers on best practices for revenue cycle management, claims submission, payment processing, collections, and denial management within our platform.
Meet or exceed established performance metrics, including customer satisfaction, resolution time, and quality benchmarks; handle a high volume of inbound calls daily, ensuring timely and accurate responses to customer inquiries.
Tebra is the digital backbone for practice well-being, formed by the merging of Kareo and PatientPop. They aim to unlock better healthcare by helping independent practices bring modernized care to patients everywhere, serving over 100,000 providers.
Manage and optimize the RevOps tech stack, ensuring high data integrity and seamless synchronization across platforms.
Build, maintain, and interpret centralized KPI dashboards, identifying trends, bottlenecks, and opportunities in our pipeline.
Partner with Revenue teams to refine workflows, reducing friction in the sales cycle and improving deal velocity.
Afresh is the leading AI company in fresh food, partnering with grocers to order billions of dollars of fresh food. They are on a mission to eliminate food waste and make fresh food accessible to all and have saved 200M lbs of food waste in 2025 alone.
Monitor and optimize network adequacy, ensuring geographic and clinical coverage meets member demand.
Define and track key performance drivers, designing reporting frameworks for real-time visibility.
Drive cross-functional strategy to bridge network gaps, partnering with Clinical, Product, and Operations teams.
Lyra Health is the leading provider of mental health solutions for employers, supporting more than 20 million people globally. They have delivered 13 million sessions of mental health care and are known for their AI-powered platform and research-backed approach, which improves access, clinical effectiveness, and cost efficiency.
Manage the day-to-day tasks of processing provider credentials, licenses and payor enrollment applications.
Work cross-functionally with many teams to guarantee the smooth running of operations.
Research, interpret, and evaluate information relevant to provider licensure and continuing medical education in the United States
CertifyOS is building the infrastructure that powers the next generation of provider data products, making healthcare more efficient, accessible, and innovative.
Document solutions in reusable articles to support future issue resolution
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries and are known for investing in their people and new advanced technologies.
Develop deep understanding of the clinical data needs and data usability requirements across Devoted Health Plans and Devoted Medical.
Analyze clinical data availability across geographical areas to develop insights about data gaps, the reasons data is not available, and opportunities to obtain data.
Implement technical integrations with Health Information Exchanges (HIEs), Labs, Electronic Health Record (EHR) systems, and other sources of clinical data and ensure quality of data received.
Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Founded in 2017, they've grown fast and now serve members across the United States.
Develop a deep understanding of our business, care programs, and data.
Synthesize data into actionable insights that improves clinical quality, operational efficiency, and outcomes.
Partner with product, clinical, engineering, and operations teams to translate business needs into analytics solutions.
Cayaba Care is working to drastically improve the experience of affected communities by reimagining how they deliver meaningful and compassionate care to expectant moms. The team is focused on building trust-based engagement and wrap-around support for expectant moms at home, in person and virtually.
Responsible for collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers.
Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage.
Process an appeal, resubmit/rebill, or forward claims for adjudication as necessary.
BillionToOne is a next-generation molecular diagnostics company on a mission to make powerful, accurate diagnostic tests accessible to everyone. Forbes recently named them one of America's Best Startup Employers for 2025, and they were awarded Great Place to Work certification in 2024.