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.
Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Accountable to meet and maintain established department production and quality standards.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Review appeals for commercial and Part D plans, rendering determinations based on clinical guidelines and regulatory requirements.
Serve as a clinical reviewer and subject matter support, performing independent research and retrospective case reviews.
Assist with CMS client audits, investigate appeal determination questions, and support clinical training activities.
MedImpact delivers leading edge pharmaceutical and technology related solutions that improve the value of healthcare, providing transparency and choice. Privately-held for over three decades, it is one of the leading pharmacy benefit managers in America, committed to making prescription benefits understandable and accessible.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Apply payer-specific guidelines and internal policies to support clear, defensible clinical narratives.
Meet assigned turnaround times and document findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable reimbursement solutions and clinical expertise, leveraging technology and analytics. The company builds long-term careers by investing in professional development and personal growth, fostering a culture of accountability and success.
Support payer audits and medical record reviews, ensuring timely submission of documentation.
Manage medical review requests and appeals associated with CMS contractors and regulatory agencies.
Review clinical documentation using audit checklists and partner with teams to gather required records.
VitalCaring is a provider of home health and hospice services founded in 2021. They are a growing company focused on quality and compliance, with a mission to deliver exceptional patient care.
Monitor and interpret CMS guidance for Medicare, Medicaid, and other healthcare programs.
Partner with internal teams to ensure compliance with regulations and contract obligations.
Maintain regulatory tracking documentation and support development of training materials.
HealthEdge provides healthcare software and services to payers and providers. It is a growing company with a focus on compliance and innovation, fostering a collaborative and remote-friendly culture.
Review and process appeals submitted by members and providers, ensuring timely and accurate resolution.
Evaluate cases, determine next steps, and manage multiple priorities while meeting strict turnaround times.
Review clinical and medical records, summarize findings for Medical Director review, and operate within turnaround times as short as 24–72 hours.
BlueCross BlueShield of Tennessee has been helping Tennesseans find their own unique paths to good health since 1945. At BCBST, they empower their employees to thrive both independently and collaboratively, creating a collective impact on the lives of their members.
Review and analyze insurance denials using EOBs, payer correspondence, and claims data to determine appropriate resolution strategies.
Differentiate between clinical and technical denials and identify required next steps for appeals or reprocessing.
Prepare and submit appeals using supporting documentation such as medical records, appeal letters, and clinical justification when necessary.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use automated technology to review applications and share top-fitting candidates directly with employers, ensuring a fair and efficient hiring process.
Investigate and resolve health plan denials for coding-related issues, including rejections, down codes, bundling, modifiers, and level of service.
Generate appeals based on dispute reasons and contract terms specific to payors, including online reconsiderations and following payer guidelines.
Maintain working knowledge of workflows, systems, and tools used in the department, adhering to production and quality standards.
Ventra is a leading business solutions provider for facility-based physicians, focusing on Revenue Cycle Management. The company partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver data-driven solutions.
Conduct clinical reviews of medical records to determine medical necessity and payer compliance.
Evaluate denial cases including appeals, audits, and no-authorization determinations.
Develop evidence-based clinical rationales aligned with payer and regulatory guidelines.
This partner company provides clinical review and healthcare reimbursement support services. The team is remote and operates in a fast-paced, performance-driven environment.
Provide medical necessity reviews using evidence-based guidelines and clinical expertise.
Conduct peer-to-peer discussions with treating providers and document decisions in workflow tools.
Support clinical content team with evidence-based literature and operational improvements.
Cohere Health's clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. Backed by leading investors and recognized on the Inc. 5000 list, the company fosters a supportive, growth-oriented culture with diverse teams.
Review assigned TEFCA directory entries against authoritative corroboration sources and apply the approved review methodology.
Research, validate, and reconcile healthcare directory data across multiple reference sources, documenting findings in Jira.
Classify entries using a four-tier disposition taxonomy and escalate exception-path entries to the Lead Analyst.
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) that provides expert program management, technology, and consulting solutions to government and private sector clients. As a small business, they emphasize integrity, collaboration, and excellence in their tailored solutions.
Adjudicate civil summonses by conducting hearings, reviewing evidence, and issuing written decisions.
Maintain timely case procedures and accurately convey agency policy to the public.
Work remotely up to 1,000 hours per year, with flexible scheduling based on agency needs.
OATH is the nation's largest administrative tribunal, holding over 250,000 trials and hearings annually. It employs a diverse workforce dedicated to fair adjudication and public access to justice.
Manage a caseload of complex workers' compensation cases including litigation and disability.
Investigate claims to determine compensability, establish reserves, and manage medical treatment.
Collaborate with clients, legal counsel, and healthcare professionals to resolve claims.
Berkley Risk provides program administration and insurance services for self-insured entities. It is a member company of W. R. Berkley Corporation, a Fortune 500 firm, offering a competitive compensation and robust benefits package.
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.
Serve as the primary point of contact for physicians, clinics, and healthcare stakeholders, ensuring consistent communication and trusted relationships.
Support healthcare providers in navigating patient assistance programs, including enrollment, reimbursement, and therapy access processes.
Manage and complete all required documentation such as special authorizations, prescription renewals, and enrollment forms with accuracy and timeliness.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use technology to ensure fair and efficient recruitment processes, and foster inclusive employee programs.
Provide clinical review and correspondence for utilization management, including medical necessity reviews and member communications.
Collaborate with Medical Directors to ensure evidence-based decisions that meet NCQA and CMS standards.
Maintain productivity and quality while working 100% remotely in a fast-paced environment.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With over 250 employees, the company fosters a supportive, growth-oriented environment and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup.
Collaborate with a multidisciplinary care team to ensure quality, member-centered care and assist members with navigating and applying for entitlement benefits.
Become an expert on available insurance and social service resources within assigned region, and provide cross-state coverage support as needed.
Maintain timely documentation in electronic health records and participate in ongoing continuing education.
Groups provides assistance to members in accessing Medicaid, Marketplace, and Medicare insurance and other entitlement benefits. The company values member-centered care and harm-reduction practices, with a team-oriented and entrepreneurial 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.
Verify insurance eligibility and benefits for all new Boulder Care commercial enrollments.
Answer incoming questions from patients about balances due and non-covered charges.
Serve as subject matter expert for internal insurance training and identify billing errors.
Boulder Care is an award-winning digital clinic for addiction medicine, recognized for innovation and high quality of patient care. Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work.