Own end-to-end handling of appeals and grievances, investigating cases and delivering resolutions within regulatory timelines.
Work directly with members and providers, coordinating with internal teams to address concerns.
Apply plan documents and regulations to make accurate determinations and draft compliant communications.
Sidecar Health is redefining health insurance by making healthcare affordable and accessible. The team is composed of passionate individuals from diverse backgrounds including tech, policy, and healthcare, all united by a mission to fix a broken system.
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.
Review Medicaid and CHIP eligibility determinations for compliance with federal and state regulations.
Prepare audit reports and documentation for program stakeholders.
Collaborate with state agencies to resolve questions and clarify eligibility procedures.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It uses technology to review applications and share top-fitting candidates directly with employers.
Review healthcare claims and determine appropriate payment methodologies based on contractual terms and client requirements.
Analyze claim information and system data to ensure accurate repricing while meeting productivity and quality metrics.
Collaborate with internal audit and operational teams to support compliance, quality assurance, and process improvement initiatives.
The company provides healthcare claims review and repricing services. It operates remotely with a focus on compliance, accuracy, and continuous improvement.
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.
Manage patient account activities to optimize reimbursement and reduce accounts receivable.
Perform billing, follow-up, collections, and denials resolution to improve financial outcomes.
Ensure accuracy of charge, claim, and payment data through reviews and targeted corrections.
The University of Kentucky is a public land-grant university dedicated to advancing education, research, and healthcare. It promotes a supportive culture that values employee well-being and professional growth.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote 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.
Provide initial training on central business office duties to new staff.
Develop into higher-level roles with two years of acceptable performance.
Piedmont Healthcare Corporate is a healthcare organization focused on revenue cycle management and central business office operations. It is a large corporate entity with a culture centered on accuracy and development.
Verify patient eligibility and analyze Medicaid claim payments to ensure proper reimbursement.
Review UB-04 billing components and prepare initial Medicaid bill packets with supporting documentation.
Conduct timely follow-up with payers, manage authorizations, and appeal denials as needed.
EnableComp provides specialty revenue cycle management solutions for healthcare organizations, using intelligent automation to improve financial sustainability for hospitals and health systems. Recognized as a Top Workplaces recipient and among the Inc. 5000 fastest-growing private companies for eleven years, the company fosters a family-oriented culture focused on employee growth.
Review patient medical records to determine why claims are denied and prepare compelling appeal arguments using clinical evidence and regulatory guidelines.
Search for supporting evidence and analyze insurance denial trends to provide feedback to hospitals and executive leadership.
Ensure compliance with HIPAA regulations and demonstrate excellent written communication skills in crafting appeal letters and hearing testimony.
PAM Health provides specialty healthcare services through over 70 long-term acute care hospitals, rehabilitation hospitals, wound clinics, and outpatient physical therapy locations in 17 states. With a collaborative culture and a focus on compassionate care, the company employs a dedicated team committed to high-quality patient outcomes and professional growth.
Reviews payor denials and audits for potential lost revenue and writes comprehensive appeal arguments using clinical criteria.
Functions as a hospital liaison with external third-party payors and works with Physician advisor team to facilitate appeals.
Monitors and reports payor trends to management, ensuring compliance with regulatory and accrediting requirements.
Jefferson Health is a nationally ranked not-for-profit health care system reimagining health care and higher education to create unparalleled value. With more than 65,000 employees, it serves patients through millions of encounters annually at 32 hospital campuses and over 700 outpatient locations in the greater Philadelphia region, Lehigh Valley, and southern New Jersey.
Eligibility Review: Review patient records and clinical documentation to determine eligibility for Form Health.
Record Collection: Manage requesting, faxing, and tracking medical records from external providers while ensuring HIPAA compliance.
File Communication: Maintain clear communication with patients and colleagues to keep them updated throughout the eligibility process.
Form Health is a virtual obesity medicine clinic that provides multi-disciplinary evidence-based obesity treatment through telemedicine. Founded in 2019, it is a venture-backed startup with an experienced clinical and leadership team, committed to a culture of inclusion and patient-first values.
Serve as primary physician reviewer for Utilization Management (UM) cases, advising other reviewers and attending daily calls with health plan teams.
Establish 2-3 cases per day for up to 6 markets, ensuring attendance on health plan calls and weekly meetings.
Participate in Process and Quality improvement in delegated Utilization Management, utilizing excellent analytical and deductive reasoning skills.
ChenMed is a family-owned, physician-led primary care provider focused on improving healthcare for moderate-to-low-income seniors. The company is rapidly expanding, with a culture of innovation, kindness, and making a difference.
Perform clinical reviews and conduct peer-to-peer discussions.
Participate in inter-rater reliability activities and clinical rounds.
Serve as a clinical resource and subject matter expert to clinical and non-clinical staff.
Devoted Health is a healthcare company that aims to improve the health and well-being of older Americans through a data and AI-driven care platform. The company values diversity, collaboration, and a supportive work environment, and is an equal opportunity employer.
Manage and resolve claims rejections and denials, escalating trends as identified.
Verify patient eligibility and benefits, and coordinate with insurance payers.
Maintain compliance with HIPAA regulations and meet productivity standards.
Workit Health is an industry-leading provider of on-demand, evidence-based telemedicine care for addiction. They are a growing company with a dedicated team passionate about making judgment-free care accessible.
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.
Lead portions of regulatory assessments, external audits, and accreditation processes for Commercial, Medicare, Medicaid, and Marketplace departments.
Act as primary point of contact for internal and external partners on regulatory activity, quality efforts, SOP development, and client delegation agreements.
Maintain regulatory gap status reporting, track work streams, and lead change management related to regulatory requirements.
Prime Therapeutics is a pharmacy benefit manager (PBM) with a purpose beyond profits, reimagining pharmacy solutions to connect care for those they serve. The company is a large, purpose-driven organization focused on simplifying healthcare and fostering a collaborative culture.
Manage insurance authorizations for clients in PHP and IOP programs, including pre-certifications and concurrent reviews.
Verify benefits, obtain Single Case Agreements, and build medical necessity cases using ASAM, LOCUS, and CALOCUS criteria.
Maintain accurate authorization, denial, and SCA records and prepare appeals on denied authorizations.
AWA and PRC are dual behavioral health organizations operating PHP and IOP programs across South Florida. They exist to serve clients and families at their most critical moments.
Reviewing time-sheets for accuracy and reconciling discrepancies.
Validating data accuracy through periodic audits.
Resolving inconsistencies by contacting the source for clarification.
We are a national organization dedicated to nurturing children with autism and special needs through applied behavior analysis. With 20 years of clinical insights, we have a caring team focused on personalized treatment plans.