Interpret federal and state regulations to ensure compliance and drive process improvements.
Analyze data in Excel to identify trends, savings, and process improvements.
SIHO Insurance Services provides health insurance administration and related services, focusing on payment integrity and regulatory compliance. The company operates in a managed care environment and emphasizes collaboration, professionalism, and adaptability among its employees.
Oversee CMS and state audit readiness, live audit management, and corrective action plans.
Build internal monitoring, training, and reporting to foster a culture of compliance.
Collaborate with clinical and operations teams to integrate audit findings into improvements.
Habitat Health empowers older adults to experience more good days through the Program of All-Inclusive Care for the Elderly (PACE), delivering coordinated medical and social care in homes and communities. Supported by leading healthcare organizations and investors, the company is expanding its scalable model with a mission-driven culture focused on participant well-being.
Perform audits of enrollment, disenrollment, eligibility, and plan/PCP change transactions for health plan enrollment associates.
Review enrollment (834) file transactions and coordinate with state systems to confirm member effective dates and eligibility.
Collate, compile, and report QA performance to management and individuals, providing feedback for improvement.
HealthEdge provides AI-powered operational infrastructure for health insurance companies. UST HealthProof has a global workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.
Perform quality audits on clinical documentation across clinical departments.
Collaborate with leadership to develop corrective action plans and provide 1:1 coaching.
Support organizational readiness for NCQA and other regulatory audits.
Oscar is the first health insurance company built around a full stack technology platform, focusing on serving members with a concierge-level experience. It started in 2012 and is an Equal Opportunity Employer cultivating an authentic, inclusive environment.
Conduct clinical audits and risk assessments to identify compliance gaps.
Manage multiple client engagements and deliver accurate project results.
Build strong client relationships and present findings to leadership.
Kodiak Solutions transforms healthcare through technology-driven solutions, specializing in finance, unclaimed property, and risk management. Their innovative platform streamlines operations, allowing providers to focus on patient care.
Evaluate the effectiveness and integrity of insurance operations across a portfolio of specialty insurance partners.
Lead and participate in reviews covering underwriting, documentation, compliance, reporting, and financial activities.
Analyze findings, identify risks, and communicate actionable recommendations to mitigate issues.
Jobgether is a platform that uses AI-powered matching to connect candidates with job opportunities. The company fosters a collaborative, remote-friendly culture and partners with various employers to streamline the hiring process.
Audit participant electronic health records to ensure complete, accurate, and timely documentation.
Identify documentation gaps and collaborate with clinical teams to improve processes and regulatory readiness.
Reconcile regulatory logs and assist with audits and investigations to maintain data integrity.
WelbeHealth is a value-based healthcare organization that provides all-inclusive care to vulnerable seniors, keeping them in their communities. The company emphasizes a supportive team culture with work-life balance and comprehensive benefits.
Independently manage Medicare, Medicaid, and TriCare cost reports and coordinate audits.
Lead the annual cost report peer-review process and manage provider appeals.
Collaborate with internal stakeholders and external reimbursement organizations to ensure compliance.
They are a large health system providing patient-focused healthcare services. The organization is collaborative and mission-driven, with a focus on financial sustainability.
Develop and maintain operational, clinical, quality, compliance, and executive dashboards supporting the LTSS program.
Transform complex healthcare, operational, and financial data into actionable insights for program oversight and improvement.
Partner with cross-functional teams to monitor performance indicators, support compliance, and drive data-informed decisions.
The hiring partner is a healthcare organization supporting a large-scale Long-Term Services and Supports (LTSS) program. The role offers substantial autonomy and cross-functional collaboration in a fully remote environment.
Conduct clinical audits for suspected fraud, waste, and abuse with high autonomy.
Document findings in formal reports, graphs, and audit logs, aligning with unit goals.
Develop and present FWA-related education to Oscar teams, ensuring compliance with regulations.
Oscar is a health insurance company built on a full stack technology platform, focused on serving members like a doctor in the family. Founded in 2012, it is a forward-thinking company that values diversity and innovation, with a culture of fostering belonging and support.
Collaborate with health plan leaders to develop quality data strategies and reporting on HEDIS and CAHPS performance.
Oversee data ingestion, validation, and documentation to improve accuracy across EHR, HIE, and supplemental data.
Support regulatory compliance and HEDIS audit readiness while monitoring quality programs and reporting risks.
This organization is a healthcare quality partner focused on national performance initiatives, including HEDIS, CAHPS, and data analytics. It provides a highly collaborative, matrixed environment with opportunities for cross-functional exposure and remote work.
Conduct quality reviews and audit revenue cycle claims and workflows against established SOPs.
Develop, collect, and analyze quality improvement initiatives to support RCM operational functions.
Identify process deficiencies via analysis and trends, and deliver assessment results to leadership.
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, and consists of scalable operations and end-to-end, cloud-based technology.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Supports and strengthens the Compliance program by providing advisory support to business stakeholders.
Conducts compliance investigations and assists with auditing and monitoring activities.
Advances policy governance and development, translating regulations into practical guidance.
Rula is a mental health company dedicated to providing evidence-based, compassionate care to treat the whole person. They are a remote-first organization with a culture that values diversity, equity, and inclusion, hiring in most U.S. states.
Develop, maintain, and optimize recurring and ad hoc HR reports, dashboards, and workforce metrics, analyzing data to identify trends and risks.
Partner with Legal, Compliance, and HR leaders to monitor adherence to employment requirements and support HR compliance framework development.
Lead solution design for HR systems, data, and processes, translating business needs into scalable requirements and validating configuration outcomes.
J.S. Held is a global consulting firm that combines technical, scientific, financial, and strategic expertise to advise clients seeking to realize value and mitigate risk. The firm provides a comprehensive suite of services, products, and data that enables clients to navigate complex, contentious, and often catastrophic situations.
Own quality performance across all clinical tiers, including call and documentation quality for RNs, providers, and PSS Engagers, plus organization-wide clinical outcomes.
Lead and develop a team of Quality Reviewers, setting standards, conducting calibrations, and coaching to ensure consistent, defensible scoring.
Build and analyze quality dashboards and datasets to identify trends, root causes, and improvement opportunities, presenting findings to executive leadership.
CareTalk Health is a fully remote, nationwide virtual medical practice partnering with Medicare Advantage plans to deliver Annual Wellness Visits and close care gaps. We are a growing, collaborative team focused on making virtual care simple, reliable, and human.
Design and maintain complex financial models to track cost-saving initiatives and provide insights.
Perform advanced data analysis to assess prior authorization trends, claims trends, and cost drivers.
Lead post-implementation assessments to measure the impact of cost-saving initiatives and ensure sustainability.
Cohere Health's clinical intelligence platform and agentic AI-powered solutions optimize the speed, cost, and quality of care. The company is a growing organization with a supportive, growth-oriented environment and has been recognized as a top startup.
Support the Consumer Compliance Department by developing and delivering reports, dashboards, and metric-level analysis to monitor compliance risk.
Analyze trends, identify patterns, and provide data-driven recommendations to improve compliance outcomes.
Collaborate with IT, business lines, and audit teams to ensure data integrity and governance for compliance programs.
Fulton Bank is a financial institution dedicated to changing lives for the better through community impact and customer service. The company champions a culture of continuous learning, work-life integration, and inclusion, with a digitally enabled work environment.
Respond to service requests from internal and external customers accurately and on time.
Maintain case documentation with precision to keep records audit-ready.
Compile and distribute monthly reports and data summaries for leadership.
Personify Health offers a personalized health platform combining health plan administration, wellbeing solutions, and care navigation. The company serves employers and health plans with data-driven solutions, fostering a mission-driven culture focused on improving health outcomes.
Convert raw medical claims (837 EDI, UB-04, CMS-1500) into canonical models applying healthcare coding standards.
Perform data quality audits and write SQL/Spark SQL queries to validate pipeline output and detect overpayment patterns.
Act as SME on claims coding, adjudication rules, and payer policy, mentoring analysts and collaborating with cross-functional teams.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients across the US. Deployed by over 85 health plans and representing more than 270 million lives, the company combines an AI-powered platform with industry expertise to maximize financial outcomes and reduce healthcare costs.