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 update client data accurately based on provided Style Guides.
Research and validate information using internal and external data sources.
Resolve data discrepancies and merge duplicate records.
Harbor provides expert services in strategy, legal technology, operations, and intelligence. With a globally integrated team of over 900 strategists, technologists, and specialists, they serve leading law firms and corporations, fostering a culture of deep knowledge and mutual respect.
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.
Execute day-to-day provider enrollment, credentialing, and licensing tasks under guidance.
Input, maintain, and update provider data across databases and internal systems.
Review and process enrollment applications, supporting documentation, and status updates.
Allara is a women’s health provider that specializes in expert, longitudinal care that supports women through every life stage. Allara makes expert healthcare accessible by connecting patients with multidisciplinary care teams and is trusted by over 60,000 women nationwide.
Review clinical documentation and treatment trajectory to ensure care meets medical necessity standards.
Synthesize clinical documentation, medical record information, and outcomes data to make recommendations on next steps in care.
Partner cross-functionally to support high-quality, clinically appropriate care across the network.
Rula is dedicated to treating the whole person and aims to create a world where mental health is no longer stigmatized. They are a remote-first company committed to providing quality, evidence-based, and compassionate care, empowering individuals to take charge of their mental health.
Manage day-to-day credentialing and re-credentialing workflows for Tia’s provider network.
Support medical licensing workflows for MDs, DOs, NPs, PAs, and RNs across multiple states, including tracking requirements, deadlines and renewals.
Track onboarding progress and help ensure providers are licensed, credentialed, enrolled, and compliant before go-live.
Tia is building a new model for women’s healthcare, one that treats women as whole people. They are a Series D, venture-backed company trusted by more than 120,000 women across four markets, building a culture of excellence in people, process, and product.
Manage the provider data ticketing queue, ensuring timely resolution of requests.
Partner with team members to obtain required data elements and validate completeness.
Identify and implement opportunities to streamline provider data structure and workflows.
Curana Health is committed to radically improving the health, happiness, and dignity of older adults. They serve 200,000+ seniors in 1,500+ communities across 32 states, with over 1,000 clinicians, care coordinators, analysts and professionals.
Manage complex provider roster creation, submission, and record reconciliation for multiple payers.
Oversee resolution of moderate-scope issues by prioritizing tasks and escalating issues with solutions.
Proactively identify areas for operational improvement and efficiency enhancement.
Aledade empowers independent primary care practices to deliver better patient 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.
Research, interpret, and evaluate information relevant to provider licensure and continuing medical education in the United States.
Complete applications for provider credential, licensure or payor enrollment on behalf of Certify customers.
Validate and authenticate information updated on the credentialing, licensing platform and ensure 100% accuracy.
CertifyOS is building the data infrastructure that powers modern healthcare. Their API-first platform automates provider licensing, enrollment, credentialing, and network monitoring by connecting directly to hundreds of primary data sources. The company values authenticity, accountability, collaboration, results, and openness to feedback.
Conduct coding audits to ensure accuracy and compliance with coding guidelines.
Identify compliance risks and recommend corrective action plans.
Provide education and training to physicians and staff on coding best practices.
Theoria Medical is at the forefront of healthcare innovation and quality, offering a blend of medical excellence and technological advancements, primarily serving the post-acute sector. Their network includes multispecialty physician services across skilled nursing facilities nationwide, fostering a mission-driven culture that values expertise and innovation.
Review medical records to identify clinical information and flag missing documentation.
Coordinate medical record requests and track case pipelines to ensure timely receipt.
Support provider and patient outreach and contribute to operational improvement projects.
Natera is a global leader in cell-free DNA testing, dedicated to oncology, women's health, and organ health. The team consists of highly dedicated professionals from world-class institutions who care deeply for their work and each other.
Processes applications for credentialing and privileging, both initial and reappointment, adhering to policies and procedures related to legal, state, OHSU, DNV, TJC, and NCQA guidelines.
Investigates and validates discrepancies and adverse information from applications and primary source verifications, communicating with credentialing contacts ensuring timely and accurate completion.
Maintains practitioner credential files, containing confidential peer review information, and updates credentialing databases with detailed documentation during all steps, from receipt of application to processing completion.
OHSU is Oregon's only public academic health center, focused on patient care, research, and training the next generation of healthcare professionals. As Portland's largest employer, OHSU provides opportunities for learning and advancement within its system of hospitals and clinics.
Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations.
Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes.
Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain.
Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. They offer a variety of health insurance products and services as well as providing information and tools to help individuals make better health decisions. At AZ Blue, they have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.
Managing the credentialing, payer enrollment, and provider onboarding processes for physicians and advanced practice providers.
Ensuring providers are credentialed, enrolled, and maintained with commercial and government payers in a timely and accurate manner.
Maintaining provider records, monitoring credentialing deadlines, and coordinating with payers and providers.
Modena Health (MH) and Modena Allergy & Asthma (MAA) are leading and rapidly growing medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona, and ambitious plans for national expansion. They are physician-led, hospitality-focused, and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Perform accurate code assignments for ED records (facility and profee) while working remotely.
Be flexible, detail-oriented and have the ability to work independently.
Meet client productivity targets while maintaining coding quality of 95% or greater.
UASI is a company that values its employees! They have been awarded the Top Workplace award by the Cincinnati Enquirer in 2022 and 2023. Their 40 years in business contributes to the long tenure of their team.
Primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements.
Assist with data collection, analysis and reporting for process improvement efforts.
Plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.
Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health has a supportive, growth-oriented environment and diverse, inclusive teams.
Interpret medical rules, regulations, fee schedules, and edits that payers post.
Understand and manipulate payer data to build federal, state, and commercial coding and financial tables.
Maximize the efficiency and use of product solutions by properly maintaining payer specific edits.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets and have an amazing team of 25,200 people in 32 countries.
Manage initial credentialing and re-credentialing applications for physicians and mid-level providers across multiple U.S. states.
Complete and maintain CAQH ProView profiles, ensuring all provider data is accurate, current, and attestation-ready.
Submit and track payer enrollment applications with commercial insurance companies, Medicare, and Medicaid programs.
AMS Solutions is a leading medical billing and revenue cycle management company serving healthcare practices across the United States. They specialize in helping physicians maximize their revenue through expert billing, coding, credentialing, and practice management services.
Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Coordinate medical record retrieval, ensuring complete and timely submission of patient documentation for provider review
Prepare and process referrals to specialists and manage prior authorization requests in coordination with insurance payors
Virtually greet and room patients prior to telehealth appointments, confirming patient information and visit readiness
Synapticure is a patient and caregiver-founded company that provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. They are dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and ALS.