Serve as the primary contact for CM/UM programs and operational questions related to the MyCare Platform.
Build relationships with provider offices through outreach and timely follow-up, resolving issues within defined turnaround times.
Educate providers on submission requirements, documentation, timelines, and available CM/UM resources.
Personify Health created a personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while improving health outcomes.
Manage the provider data ticketing queue, ensuring timely resolution of requests.
Partner with team members to obtain required data elements and validate completeness.
Identify and implement opportunities to streamline provider data structure and workflows.
Curana Health is committed to radically improving the health, happiness, and dignity of older adults. They serve 200,000+ seniors in 1,500+ communities across 32 states, with over 1,000 clinicians, care coordinators, analysts and professionals.
Manage complex provider roster creation, submission, and record reconciliation for multiple payers.
Oversee resolution of moderate-scope issues by prioritizing tasks and escalating issues with solutions.
Proactively identify areas for operational improvement and efficiency enhancement.
Aledade empowers independent primary care practices to deliver better patient care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Facilitate client calls related to contracting and payer enrollments.
Run and analyze client KPIs, providing regular reports.
Manage the full contracting and payer enrollment process.
Experity transforms on-demand healthcare across the U.S. by empowering urgent care clinics with industry-leading software. The company fosters a team-first culture with opportunities for flexible work and career development.
Interpret medical rules, regulations, fee schedules, and edits that payers post.
Understand and manipulate payer data to build federal, state, and commercial coding and financial tables.
Maximize the efficiency and use of product solutions by properly maintaining payer specific edits.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets and have an amazing team of 25,200 people in 32 countries.
Handle provider inquiries through multiple channels with accuracy and precision.
Establish and maintain positive relationships with providers on behalf of the company.
Complete ongoing training to stay abreast of products, services, and policy changes.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association offering health insurance. It is consistently voted one of the "Best Places to Work in PA" and values employee growth and community involvement.
Set up and validate projects across multiple systems with accuracy and completeness.
Maintain project details, statuses, and billing oversight while managing stakeholder follow-ups.
Support communication via call queue and email, and assist with special ad hoc initiatives.
J.S. Held is a global consulting firm combining technical, scientific, financial, and strategic expertise to advise clients on value realization and risk mitigation. The firm provides comprehensive services to help clients navigate complex, contentious situations, and its team operates in a high-energy, collaborative environment.
Actively engages with Benefits Administration system to complete new and renewing account installation.
Provides assistance to internal and external clients with basic BenAdmin Q&A, reports, troubleshooting and data questions.
Consistently achieves or exceeds established SLA expectations on individual performance.
CRC Benefits is an industry leading provider of benefits services, with a culture focused on inclusion, trust, collaboration, and innovation. The company has earned a Top Workplaces USA award three years in a row based solely on employee feedback, valuing employees and encouraging growth.
Support PBA account teams with day-to-day client requirements and benefit management.
Analyze client requests and coordinate with internal and external teams to execute plan documentation.
Lead quality assurance testing, claim reviews, and resolve sponsor and member issues.
Judi Health is an enterprise health technology company providing a comprehensive suite of PBM and health benefit management solutions for employers and health plans. They value diversity and are committed to rebuilding trust in healthcare in the U.S.
Drive scaling and adoption of virtual services within Privia's network and externally.
Conduct market analysis to identify targets and support sales enablement.
Serve as central contact for new providers and execute marketing campaigns.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups and health systems to optimize practices and improve patient experiences. The company is led by top talent and physician leadership, with scalable operations and cloud-based technology.
Administer and maintain Salesforce instance, including users, permissions, workflows, and dashboards.
Generate weekly reports on pipeline, deals, forecasts, and cross-functional data requests.
Ensure CRM data accuracy, perform audits, and provide analytical insights to drive business action.
Transcarent is a digital health company that brings together benefits navigation, clinical guidance, and care delivery in one platform, focusing on reducing costs and improving outcomes for employers and health plans. With over 1,700 employers and health plans serving 21 million members, the company values people first, resilience, results, and humility in a collaborative culture.
Deliver an outstanding customer experience by supporting inquiries across phone, email, text, and chat.
Manage high-complexity insurance workflows and inbound support requests to collect documentation.
Partner with clinical, scheduling, and operations teams to ensure accurate treatment plan alignment and continuity of care.
Expressable is a virtual speech therapy practice that aims to transform care delivery and expand access to high-quality services. Since 2019, they serve thousands of clients with a focus on parent-focused intervention and an e-learning platform with home-based learning modules.
Responsible for processing insurance claims accurately and efficiently.
Analyze claim data to identify trends, errors, and potential irregularities.
Serve as a liaison between departments to support seamless claims resolution and continuous process improvement.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a fast-growing company serving over 200,000 seniors in 1,500+ communities across 32 states.
Conduct proactive patient outreach initiatives to identify and address quality gaps.
Collect quality data using various methods of data sourcing-EMR, claims, provider outreach.
Communicate quality performances, barriers and improvement strategies both internally and with customers.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Own and evolve the operating model for Maven’s Client Support function.
Lead and develop a team of Client Support Associates.
Bring the operational perspective into Product and Engineering conversations.
Maven Clinic is the world's largest virtual clinic for women and families, aiming to make healthcare work for everyone. They provide clinical, emotional, and financial support through a digital platform, trusted by over 2,000 employers and health plans, and they have an award-winning culture.
Build and maintain core VBC performance metrics across risk, quality, utilization, and cost domains.
Develop customer-facing analytics and dashboards surfacing actionable performance insights.
Analyze Medicare Advantage data to identify gaps and opportunities at multiple levels.
Counterpart Health is an AI-powered physician enablement platform delivering clinical insights to providers at the point of care. As a subsidiary of Clover Health, we have a remote-first culture with a focus on diversity and inclusion.
Execute data analysis of trends and strategic opportunities for quality improvement across Affordability Initiatives portfolio.
Track project milestones, timelines, and deliverables from live and asynchronous engagements - ensuring alignment with initiative-specific program goals.
Maintain and provide consistent tracking of KPIs and other performance metrics to enable measurement of programs and project outcomes
Aledade empowers the most transformational part of our health care landscape - independent primary care. Since being founded in 2014, Aledade has become the largest network of independent primary care in the country, helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. They foster a collaborative, inclusive and remote-first culture.
Participate in the planning and execution of the team’s work to maximize the impact of QuestBridge’s programs for high school students.
Provide operational support to college partners enabling their participation in QuestBridge programs.
Develop communications and resources for college partners, ensuring messaging is presented in a clear and concise way.
QuestBridge connects high-achieving students from low-income backgrounds with educational and career opportunities. From its founding over 30 years ago, QuestBridge has always been an organization focused on creating opportunities for students from low-income backgrounds.
Prepare materials such as board presentations and meeting minutes for ACO board meetings.
Coordinate key events like ACO retreats and kick-offs for providers and field teams.
Design and implement key reports using business intelligence and CRM tools.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, it has become the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.
Provides implementation support and management of MRO applications, including data gathering and configuration.
Serves as primary resource during implementation for internal and external teams on application setup and functionality.
Develops and maintains documentation to transition applications to support team, ensuring proper escalation procedures.
MRO provides Curation technologies and MRO application solutions for healthcare partners. The company offers a remote-first work environment and a comprehensive benefits package, focusing on client relations and employee support.