Ensure timely and accurate adjudication and payment of medical claims.
Process appeals and disputes by gathering and verifying claim information.
Work independently and as part of a team to meet daily processing quotas.
Sana is a health plan solution built for small and midsize businesses, designed around integrated primary care. Founded in 2017, Sana is remote-first with a fully distributed team across the U.S., valuing curiosity, ownership, and speed.
Manage a caseload of post-payment Workers' Compensation bills, including disputes and negotiations.
Conduct proactive outreach to medical providers to resolve disputes and negotiate reductions.
Ensure compliance with state-specific regulations and maintain productivity standards.
Reliant Health Partners is an innovative medical claims repricing service provider that helps employers achieve maximum health plan savings with tailored services. The company values diversity and inclusion, fostering a collaborative environment as an equal opportunity employer.
Manage a 4-person state arbitration production team, driving accountability and quality.
Develop repeatable processes for state arbitration workflows and support expansion into new markets.
Partner cross-functionally to integrate state arbitration processes with the broader dispute lifecycle.
Pivotal Health is a leading technology platform that helps healthcare providers get paid fairly using AI-driven tools. The company has a collaborative, low-ego team and hires primarily around Los Angeles and New York, with remote and hybrid flexibility for exceptional talent.
Investigate and analyze Motor Vehicle Accident accounts to coordinate insurance benefits and resolve outstanding balances for clients.
Conduct online medical research, review medical records, and manage claim life cycles using proprietary systems and tools.
Communicate with payers, attorneys, and clients to resolve claims, handle denials, and identify trends for prevention.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its E360 RCM intelligent automation platform. The company is a multi-year recipient of the Top Workplaces award, ranked #1 by Black Book in 2024, and has been on the Inc. 5000 fastest-growing companies list for eleven years, fostering a culture centered on professional growth and employee investment.
Review and process healthcare claims in accordance with payer requirements and established procedures
Verify claim information for accuracy, completeness, and consistency before submission
Work with billing and coding teams to investigate and resolve claim-related issues
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. They foster a remote work environment and value accuracy, teamwork, and continuous improvement.
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.
Prepare and file stop loss claim submissions, assessing eligibility against policy terms and gathering required documents.
Build and maintain claimant files, ensuring accurate and audit-ready records throughout the claim lifecycle.
Track and recover outstanding reimbursements, monitoring requests and following up with carriers to drive resolution.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. The company serves employers, health plans, and health systems with data-driven solutions and is on a mission to empower people to lead healthier lives.
Enroll practitioners in health plans accurately and timely, monitoring progress and ensuring completion.
Validate and maintain provider enrollment forms, applications, and tracking systems.
Communicate with internal teams to meet enrollment goals and target start dates.
Pediatrix Medical Group is one of the nation's largest providers of prenatal, neonatal and pediatric services. With a focus on team approach, the company is home to a diverse group of business professionals dedicated to improving patient lives.
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.
Conduct quality assurance and audit planning for the WTC Health Program, reviewing claims and analyzing data to identify trends and issues.
Research federal payer coverage policies and develop program policies and procedures, maintaining the health plan codebook.
Collaborate with clinicians and subject matter experts to support medical management and claims review, ensuring accurate application of medical coding standards.
Advanced Technologies & Laboratories International (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit for the World Trade Center Health Program. The company offers a competitive total compensation package including paid leave, medical, dental, vision, and a 401(k) retirement plan.
Resolve disputed medical claims and investigate billing discrepancies.
Work with medical staff, payers, and external agencies to resolve claim issues.
Maintain accurate billing records and ensure compliance with Medicare, Medicaid, and third-party payer requirements.
The company is a healthcare organization seeking a Biller to handle medical billing and claims resolution. The culture emphasizes accuracy, professionalism, and organization in a remote setting.
Perform comprehensive chart reviews to ensure documentation supports accurate HCC reporting.
Identify claims correction opportunities and submit them for processing.
Provide provider education and analyze coding trends for assigned medical groups.
Dignity Health Medical Foundation is a California nonprofit providing comprehensive health care services across the state. As part of Dignity Health, one of the largest U.S. health systems, it emphasizes purposeful work and staff growth.
Investigate and research health insurance claims to ensure maximum payment for hospitals and medical providers.
Follow up on unresolved commercial, Medicare, and Medicaid claims to facilitate payment.
Support the team with denial reports, audits, and overall tasks in a fast-paced environment.
Revecore helps hospitals recover earned revenue so they can continue serving patients and communities. Trusted by 1,300+ hospitals across 48 states, it combines specialized expertise with proprietary technology and fosters a supportive, innovative culture.
Manage end-to-end credentialing and payer enrollment activities with minimal supervision.
Ensure provider readiness, accurate records, and compliant documentation across multiple systems.
Serve as a knowledgeable resource for less experienced team members and support cross-functional processes.
Our partner is a healthcare organization focused on credentialing and provider network management. They offer a mission-driven, inclusive environment with a focus on collaboration and continuous learning.
Analyze and define medical group contracts for various payers including Medicare, Medicaid, and Commercial.
Interpret payer contracts and reimbursement provisions for accurate system configuration.
Validate claim valuations and troubleshoot discrepancies to ensure proper reimbursement.
Experian is a global data and technology company that powers opportunities for people and businesses worldwide. With over 25,200 employees across 32 countries, we foster a people-first, inclusive culture.
Maximize reimbursement by collecting outstanding balances from insurance companies through claim follow-up and appeals.
Resolve aged claims via payer portals and outbound calls, escalating for reconsideration and up to three levels of appeals.
Identify denial trends and collaborate cross-functionally to improve upstream processes and prevent future denials.
CareDx is a leading precision medicine diagnostics company advancing care in transplant, specialty oncology, and cell therapy. The company partners with healthcare providers and biopharma organizations to improve patient outcomes through molecular diagnostics and digital health solutions.
Manage provider credentialing, recredentialing, and enrollment processes including application review and verification.
Maintain credentialing files, databases, and tracking systems for license renewals, certifications, and DEA registrations.
Apply for provider participation with insurance networks, Medicare, Medicaid, and other payer panels, monitoring application status.
Wellpath provides healthcare to underserved and vulnerable populations, including those in correctional facilities. With a large team and a people-first culture, they emphasize compassion, collaboration, and innovation in their mission to heal the world.
Handle inbound and outbound member and provider inquiries via phone, email, and chat with professionalism and empathy.
Provide accurate information on benefits, eligibility, claims, prior authorization, billing, and provider portal support.
Collaborate with internal teams to resolve complex cases, identify process improvements, and meet performance goals.
XO Health is the first health plan designed by and for self-insured employers, delivering a unified health experience for members, providers, and payers. We are growing a multi-disciplinary team of diverse and digitally empowered employees committed to rebuilding trust in healthcare through transformation.
Manage provider credentialing, licensing, and payer enrollment activities from application through completion.
Research and resolve non-routine credentialing and provider data discrepancies, ensuring compliance.
Maintain accurate provider records, monitor deadlines, and communicate with stakeholders to prevent delays.
The company is a partner organization that manages hiring for healthcare credentialing roles. They operate remotely and foster a collaborative, deadline-driven culture focused on compliance and operational excellence.
Manage end-to-end credentialing and recredentialing processes for healthcare providers.
Coordinate payer enrollment applications and ensure timely processing across commercial and government payers.
Maintain accurate credentialing files in compliance with regulatory standards and support cross-functional teams.
Knownwell is a weight-inclusive healthcare provider offering obesity care, primary care, nutrition counseling, and health coaching. Backed by $50M in funding from investors like CVS Health Ventures and a16z, they are scaling fast to expand access to evidence-based obesity care nationwide.