Perform advanced healthcare payment audits by analyzing claims data and identifying discrepancies.
Develop and improve audit concepts focused on payment accuracy and reimbursement policies.
Collaborate with audit, engineering, and business teams to ensure accurate findings and process improvements.
Jobgether is an AI-powered job matching platform that uses technology to connect candidates with roles. The company operates remotely and focuses on efficient, objective hiring processes.
Perform complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules.
Collaborate with operations consultants, RCM AR staff, and management to address Care Center payment performance audits and maximize cash flow.
Identify, monitor, and manage denial management trends, and work closely with Revenue Cycle Teams and payer representatives.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, focusing on reducing healthcare costs and improving outcomes.
Analyze claim selection processes and AI-enabled methodologies to optimize payment integrity outcomes.
Collaborate with data scientists and analytics teams to validate coding and reimbursement accuracy.
Serve as subject matter expert in healthcare billing, coding, and regulatory compliance.
Cotiviti is a healthcare payment integrity company that leverages data and AI to improve claim accuracy and compliance. They are a large organization with a collaborative culture focused on innovation and operational excellence.
Own the program's analytics pipeline including claims records, eligibility files, and MAO-004 reconciliation across all clients.
Lead care-gap identification and closure reconciliation, ensuring accuracy for billing and client audits.
Deliver practice-level performance analysis and build funnel instrumentation to identify value leakage.
Covera Health combines clinical expertise, advanced AI, and radiology quality data to improve diagnostic accuracy. Backed by Insight Partners, the company supports nearly 6 million people across major employers and health plans, with a culture focused on meaningful work and saving lives.
Partner with senior client service managers to support client accounts throughout implementation and ongoing service delivery.
Assist with project coordination, tracking timelines, deliverables, and client requirements.
Serve as a key point of contact between internal teams and client stakeholders to facilitate effective communication.
The company specializes in client service and support solutions for the healthcare sector. It offers a remote-first culture with a focus on collaboration, innovation, and professional growth.
Research and follow up on unpaid insurance claims via mail and phone.
Review and appeal underpaid or rejected claims, coordinating with collection agencies as needed.
Respond to customer inquiries, resolve billing discrepancies, and maintain accurate records.
Accendra Health simplifies healthcare by delivering essential products and services beyond traditional settings, with a focus on home-based care. With over 6,000 teammates across 250 locations nationwide under the Apria and Byram Healthcare brands, we are dedicated to personalized care and accessible health solutions.
Provide effective and timely customer service for members, providers, and insurers regarding health care claims.
Ensure timely follow-up and organize health insurance paperwork and medical records.
Communicate status updates, negotiate with providers, and appeal claim denials on behalf of plan members.
Included Health is a healthcare company delivering integrated virtual care and navigation. They aim to raise the standard of healthcare for everyone, offering care guidance, advocacy, and personalized virtual and in-person care.
Own HIPAA-compliant source-of-truth artifacts governing Medicare claims business rules.
Validate changes internally and communicate updates to external CMS stakeholders.
Bridge product and engineering by translating policy needs into clear requirements.
Nava is a consultancy and public benefit corporation working to make government services simple and effective. Since 2015, they have helped federal, state, and local agencies solve technology modernization challenges, and they are a remote-first team with a collaborative culture.
Act as a subject matter expert on medical payment policy, analyzing client data and presenting new policy opportunities to health plans.
Collaborate with Client Medical Directors and internal teams to develop and advocate for adoption of medical policies that maximize value.
Prepare presentations, coordinate reviews, and inspire trust as a trusted advisor for the Health Plan's medical payment strategy.
Cotiviti is a healthcare analytics company that partners with health plans to optimize payment accuracy and medical policy through data-driven solutions. The company employs a global workforce and fosters a collaborative, client-focused culture.
Analyze customer data and operational insights to identify trends and areas for improvement.
Partner with enterprise customers to understand goals, challenges, and success metrics.
Collaborate with cross-functional teams to ensure effective use of solutions and achieve desired outcomes.
This partner company enables healthcare organizations to adopt innovative technology solutions. They are a mission-driven organization focused on improving patient care delivery.
You process patient payments and manage payment plans with accuracy and empathy.
You handle insurance verification, claims support, and billing education for patients.
You research account issues and resolve billing discrepancies while maintaining professionalism.
Privia provides healthcare billing and payment solutions, helping patients with insurance claims and financial responsibilities. They operate with a remote team and emphasize compassionate, compliant service.
Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools.
Partner with data science teams to validate AI outputs and improve model performance.
Serve as a coding subject matter expert to support audit concept development and optimization.
Cotiviti is a healthcare analytics company specializing in payment integrity and data-driven solutions. The company fosters a collaborative culture and emphasizes innovation in healthcare audit and analytics.
Handle incoming calls in a fast-paced call center environment, assisting members with benefits, eligibility, and claims inquiries.
Maintain composure and positivity while de-escalating challenging situations and managing relationships with members.
Apply standard operating procedures and recommend process improvements for a better member experience.
Blue Cross and Blue Shield of Minnesota is a nonprofit health insurance company committed to transforming healthcare. It is one of the most recognized healthcare brands in Minnesota with a large network of doctors and a culture based on collaboration and integrity.
Interpret partner contracts to configure business rules in healthcare systems.
Perform data analysis, create reports, and support operational decisions.
Collaborate with clients through training, implementation, and process improvement.
The company is a healthcare management technology organization that provides system solutions and services. It fosters a collaborative, innovative culture with a focus on quality and efficiency.
Investigate and resolve consumer and commercial billing issues, analyzing account discrepancies and negotiating settlements.
Communicate professionally with customers and provide timely updates on billing outcomes.
Document all investigations and collaborate with internal teams to improve billing processes.
They support healthcare organizations by ensuring accurate, timely, and effective resolution of complex billing matters. Their team is collaborative, remote, and focused on operational excellence with a supportive culture.
Review and process medical, supplemental, or dental claims according to benefits, eligibility, and guidelines.
Validate accuracy of medical codes, assess eligibility, and evaluate authorizations in claim submissions.
Meet or exceed quality and productivity goals while working independently in a virtual environment.
The Cigna Group is a health services company dedicated to improving the health and vitality of those they serve. It is a large organization with a focus on innovation and employee well-being.
Assist with payroll processing, including data validation, report review, and reconciliation to ensure accuracy and compliance.
Support tax administration, employee inquiries, and year-end payroll activities while maintaining audit-ready documentation.
Collaborate with Payroll, HR, Finance, and external providers to improve payroll processes and employee experience.
Jobgether uses AI-powered matching to connect candidates with jobs. They partner with hiring companies and manage applications, focusing on objective and efficient recruitment.
Receive, analyze, research, and resolve incoming dispute claims and first payment default cases while meeting service-level expectations.
Investigate transaction details, identify root causes, and determine appropriate outcomes using sound judgment.
Communicate professionally with customers, merchants, financial institutions, and internal stakeholders through phone, email, and written correspondence.
Our partner is a growing financial services company focused on operational excellence and dispute resolution. The company fosters a remote, collaborative culture with a focus on reducing financial losses and improving service quality.
Conduct comprehensive reviews of premium audits, ensuring accuracy and compliance with quality standards.
Analyze audit trends and data to identify improvement opportunities and support quality assurance initiatives.
Mentor and support audit teams through onboarding, training, and ongoing knowledge sharing.
The partner company specializes in premium insurance audit review and quality assurance. The company offers a fully remote work environment with comprehensive benefits.