Source Job

• Manages client denials and concerns through analytic review of clinical documentation.
• Delivers final determination based on skillsets and partnerships with Humana parties.
• Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.

Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.

• Ensure timely and accurate payment of medical claims, following health plan policies and procedures.
• Maintain accurate and up-to-date notes of all claims processed.
• Process appeals and disputes by gathering and verifying claim information and communicating outcomes.

Sana Benefits aims to create an easy healthcare experience. They focus on providing seamless care and affordable benefits to small businesses.

• Oversee the end-to-end billing process.
• Maintain comprehensive billing records, monitor and report key performance indicators related to claims submission, denial resolution, and payment posting.
• Serve as the primary point of contact for internal teams and external payers.

Apollo Behavior is the premier provider of ABA therapy in metro Atlanta, and the largest ABA provider based in Georgia.

• 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.

• Support patients through the denial and appeal process.
• Coordinate with healthcare providers and insurance companies.
• Ensure seamless access to our innovative DME device.

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Their team is dedicated to delivering prescription-grade therapy with an outstanding user experience and has pioneered the world’s first drug-free wearable therapy.

• Provides support in the functional areas of the Revenue Cycle, including Billing, Reimbursement, and Insurance Recovery.
• Ensures adherence to company policies, procedures, and related government regulations.
• Prepares and submits claims to various insurance companies electronically or on paper.

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being.

The Insurance Reimbursement Specialist maximizes reimbursement by collecting outstanding balances from insurance companies. The Specialist follows up on unresolved claims and escalates claims for reconsiderations. The Specialist works with CareDx Payer Dispute Resolution/Market Access teams ensuring proper reimbursement from payers.

CareDx, Inc. is focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients.

Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. Maintain adequate documentation on the client software to send the necessary documentation to insurance companies. Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.

You’ll help connect providers, patients and communities with innovative solutions that create real value by supporting both the financial and clinical sides.

• Navigate the Medicare system for patients and caregivers.
• Manage care coordination and logistics, including specialist visits.
• Advocate for patients by identifying billing errors and cost-saving programs.

Carewell is dedicated to providing a trusted retail source for caregiving products, offering expert-vetted items like incontinence supplies and mobility aids. They are recognized as one of the fastest-growing companies in the US, committed to improving teams, partnerships, and solutions.

Request, receive, process, and track medical and billing records from healthcare providers. Organize, scan, upload, and maintain medical and legal documents within designated firm systems. Review and verify medical records and billing statements for accuracy, completeness, and consistency.

Keller Postman represents a broad array of clients in class and mass actions, individual arbitrations, and multidistrict litigation matters.

• Evaluate and review all appeals requests to render coverage determinations based on clinical criteria and medical necessity.
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers.
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.

Judi Health offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® the industry’s leading proprietary Enterprise Health Platform (EHP). Together with our clients, they’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.

The Medicare Collections & Recoupment Specialist manages Medicare accounts receivable, focusing on payment takebacks, recoupments, and demand letters issued by Medicare. This role ensures timely response to Medicare payment adjustments and appeal determinations related to wound care services. The specialist works closely with billing, coding, clinical, and compliance teams to protect revenue while maintaining compliance with CMS and MAC requirements.

Skilled Wound Care is dedicated to delivering exceptional wound care services with compassion and expertise, ensuring optimal healing outcomes for our patients.

• Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
• Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
• Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.

Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.

• Work remotely to enhance member management and navigate the healthcare system.
• Promote wellness and assist members in achieving their healthcare goals.
• Conduct telephonic outreach, data analysis, clinical review, and documentation.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, improving patient health, and restoring provider fulfillment.

• Multi-task position covering main functions of the Central Business Office.
• Accurately handle at least one unit function of the Central Business Office.
• Monitor billing errors and claim/line item rejections.

Piedmont Healthcare is a company in the healthcare sector, though further details are not given in the job description.

Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.

Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.

• Serve as the vendor’s lead clinical subject matter expert on clinical denials management and prevention.
• Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
• Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments.

EnableComp offers specialty revenue cycle management solutions for healthcare organizations, leveraging industry expertise and its E360 RCM intelligent automation platform. EnableComp has received the Top Workplaces award multiple times and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

• Perform accurate data entry of accounts payable invoices
• Review invoices for completeness, accuracy, and proper approvals
• Maintain and update vendor records, including W-9 documentation

Ennoble Care provides mobile primary care, palliative care, and hospice services with clinicians going to the patient's home. They offer continuum of care for those with chronic conditions and limited mobility; they value employees who want to make a difference.

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.

Make outbound calls to schedule appointments for preventative health screenings. Assist members and patients with benefits and insurance information. Conduct surveys and make a difference in someone’s life!

Carenet Health has pioneered advancements for an experience that touches all points across the healthcare consumer journey.