Perform data mapping activities, translating client data into defined global and consumer data standards according to Cotiviti requirements.
Collaborate with internal stakeholders to analyze, understand, and document data requirements and transformation rules.
Explore large and complex datasets to identify trends, patterns, and anomalies.
Cotiviti transforms information into actionable insights that fuel business growth and innovation. They offer a dynamic environment where priorities can shift quickly based on business needs, but specific employee numbers are not mentioned in the job description.
Lead prospective claim review audits related to clinical DRG coding compliance and readmissions programs.
Act as Subject Matter Expert to counsel other team members across Clover on clinical coding guidelines.
Collaborate with teams across Clover to ensure provider understanding of Payment Integrity recommendations.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most; they are passionate and mission-driven individuals.
Proactively review trends in outstanding A/R, denials, and various payment issues.
Pull and join multiple data sources together, including the use of SQL and API calls.
Communicate findings and recommendations with department and cross functional leadership.
BetterHelp aims to remove barriers to therapy and make mental healthcare accessible. They are the world's largest online therapy service with over 30,000 licensed therapists, focused on employee well-being and professional development.
Review, analyze, and reconcile pharmacy claims and payments data.
Configure vendors for payment processing in our financial system.
Ensure accurate and timely processing of pharmacy, member, and provider payments and remittances.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have full-service health benefit management solutions and consolidate all claim administration-related workflows in one scalable, secure platform.
Manage analytics and machine learning projects from kick-off to completion.
Partner with subject matter experts to deliver actionable findings.
Communicate effectively with team members while working remotely.
Jobgether is an AI-powered matching service that connects candidates with companies. They ensure applications are reviewed quickly, objectively, and fairly against the role's core requirements.
Manage commission recovery workflows across online travel agency (OTA) partners.
Drive process consistency and identify systemic issues to prevent errors.
Partner with Distribution, Billing, Finance, and Sales teams.
Choice Hotels International, Inc. is one of the largest lodging franchisors in the world, offering a range of high-quality lodging options. With 7,500 hotels in 45+ countries and territories, they are the hotel company for those who choose to bet on themselves.
Establish and monitor performance metrics to measure the reliability and latency of payer data feeds.
Serve as the primary point of escalation for high-priority payer data issues, coordinating with various teams.
Oversee the documentation and submission processes for clinical data extracts to ensure audit readiness.
Aledade empowers independent primary care practices to deliver better patient care and thrive in value-based care. As the largest network of independent primary care in the country, they focus on creating value-based contracts, strengthening care continuity, and aligning incentives to ensure physicians are paid for keeping patients healthy.
Execute and manage a set list of rotating task assignments centered on monitoring incoming and outgoing files, and data syncing across systems.
Understand and facilitate account structure updates for eligibility and accumulator requirements. Validate system configurations for accuracy by monitoring inbound files from external partners.
Monitor ongoing operations and provide troubleshooting support for our claims adjudication processes including eligibility, accumulators, reporting, and syncing of systems with data.
SmithRx is a rapidly growing, venture-backed Health-Tech company disrupting the Pharmacy Benefit Management (PBM) sector with a next-generation drug acquisition platform. They are proud of their mission-driven and collaborative culture that inspires employees to do their best work.
Responsible for the maintenance of relevant provider data for use in network development and contracting, provider relations, marketing & communications, contracting, and more.
This role will also work with other network development teams to support provider data management across the CommonSpirit enterprise, including contracting and credentialing teams, to complete requests and support network operations.
Collect, validate, and maintain provider data to support marketing, provider relations, network contracting, credentialing across all lines of business.
Dignity Health Management Services Organization (Dignity Health MSO) aims to establish a system-wide integrated physician-centric, full-service management service organization structure. They offer various management and business services, leveraging economies of scale and leading efforts in developing Dignity Health’s Medicaid population health care management pathways.
Data management of all processes for the Open Enrollment period.
Processing waiver approvals via data downloads and sending emails.
Updating students’ accounts in Banner and the tracking system.
Georgetown University comprises two unique campuses in the nation’s capital, offering rigorous academic programs and unparalleled opportunities to engage with Washington, D.C. It is a close-knit group of remarkable individuals driven by intellectual inquiry and a commitment to making a difference in the world.
Accountable for configuration, load, and maintenance of data.
Provide customers with subject matter expertise in Judi’s capabilities.
Devise a repeatable process for implementing data in Judi.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. 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.
SmithRx is a rapidly growing Health-Tech company aiming to disrupt the Pharmacy Benefit Management (PBM) sector. With hundreds of thousands of members onboarded since 2016, they have a mission-driven and collaborative culture.
Assist providers in identifying, reviewing, and validating patient accounts in a credit balance state
Manage accounts receivables to ensure timely collection of identified Client overpayments
Prioritize workload to meet deadlines and goals using guidelines set out by manager
TREND Health Partners is a tech-enabled payment integrity company, dedicated to facilitating collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. It is a dynamic growing organization that promotes a collaborative and innovative work environment.
Ensure coordination of provider invoice activities to support timely reimbursement.
Research and resolve claim denials that fail payer edits, preparing corrections and appeals.
Verify patient eligibility, benefits, and health‑plan information using payer databases.
CareCentrix supports value-based care by providing care management and transition of care services. They focus on improving patient outcomes and managing healthcare costs through a range of programs and services. The company values caring, doing the right things and striving for excellence.
Serve as a subject matter expert for front-end revenue cycle functions.
Investigate and resolve complex billing issues that prevent claims from being successfully accepted by payers.
Conduct root cause analysis on recurring front-end issues and implement process improvements to reduce claim errors and rework
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions.
Review and audit medical claims for accuracy and compliance.
Listen to customer service phone calls for accuracy and professionalism.
Prepare reports on audit findings and recommendations for process enhancements.
Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They focus on cost containment strategies with innovative solutions. The posting does not specify the number of employees or further details about the culture.
Manage complex provider roster creation, submission, and record reconciliation.
Oversee resolution of moderate-scope issues by prioritizing tasks.
Serve as main contact for roster inquiries, collaborating with internal teams and external payers.
Aledade empowers independent primary care practices to deliver better 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.
Maintain and validate employee payroll data within internal systems.
Perform structured data checks and reconciliations to identify and resolve discrepancies.
Partner closely with Payroll Specialists and Managers to support payroll cycle readiness across Americas countries.
Remote is solving modern organizations’ biggest challenge – navigating global employment compliantly with ease. Their team works tirelessly on ambitious problems, asynchronously, around the world and encourages every member to bring their talents, experiences and culture to the table to help them build the best-in-class HR platform.
Serve as a key point of contact for patients regarding billing questions, payment plans, and account resolution
Respond to inbound calls and proactively reach out to patients to collect past-due balances and arrange payments
Review and explain Explanation of Benefits (EOBs) to patients in a clear and supportive manner.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions. They are transforming the way care is delivered with a focus on patient comfort and convenience, empowering their team to thrive while living their core values.