Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools.
Partner with data science teams to validate AI outputs and improve model performance.
Serve as a coding subject matter expert to support audit concept development and optimization.
Cotiviti is a healthcare analytics company specializing in payment integrity and data-driven solutions. The company fosters a collaborative culture and emphasizes innovation in healthcare audit and analytics.
Develop and maintain audit concepts by researching regulatory, coding, or payer policy changes and updating rule documents and code lists.
Perform QA reviews to ensure audit concepts comply with coding standards, payment methodologies, and payer policies prior to deployment.
Collaborate with cross-functional teams including operations, clinical, and client services to support policy execution and drive concept quality.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering value and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, we are a digital-first, AI-powered platform that reimagines what's possible in healthcare.
Support high-priority transformation initiatives in the Office of the CEO, focusing on scaling value-based care insights into EHR workflows.
Conduct sophisticated data analysis and coordinate project plans across multiple stakeholders to inform decision making.
Adopt and master AI tools to enhance impact and reach in driving Aledade's performance and growth.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care, founded in 2014. As the largest network of independent primary care in the country, they foster a collaborative, inclusive, and remote-first culture with a focus on public health and continuous learning.
Act as a subject matter expert on medical payment policy, analyzing client data and presenting new policy opportunities to health plans.
Collaborate with Client Medical Directors and internal teams to develop and advocate for adoption of medical policies that maximize value.
Prepare presentations, coordinate reviews, and inspire trust as a trusted advisor for the Health Plan's medical payment strategy.
Cotiviti is a healthcare analytics company that partners with health plans to optimize payment accuracy and medical policy through data-driven solutions. The company employs a global workforce and fosters a collaborative, client-focused culture.
Perform daily audits on client data for completeness and accuracy of coding using clinical knowledge.
Respond to provider appeals and meet client turnaround time and KPI goals.
Utilize coding validation training to become familiar with claims payment policies and regulations.
Cotiviti is a healthcare analytics company that uses data-driven solutions to improve payment accuracy and quality in healthcare. The company offers a competitive benefits package and fosters a collaborative, fast-paced work environment.
Own the program's analytics pipeline including claims records, eligibility files, and MAO-004 reconciliation across all clients.
Lead care-gap identification and closure reconciliation, ensuring accuracy for billing and client audits.
Deliver practice-level performance analysis and build funnel instrumentation to identify value leakage.
Covera Health combines clinical expertise, advanced AI, and radiology quality data to improve diagnostic accuracy. Backed by Insight Partners, the company supports nearly 6 million people across major employers and health plans, with a culture focused on meaningful work and saving lives.
Collaborate with clients and internal stakeholders to understand payment integrity requirements and integrate analytical outputs.
Drive AI adoption by prompting LLMs and building automated workflows to accelerate analysis.
Write and maintain complex analytical SQL, including window functions and CTEs, against large-scale healthcare claims datasets.
Machinify is a leading healthcare intelligence company that delivers value and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company fosters a culture of innovation and disruption.
Reconcile daily payment batches in Candid against bank deposits and resolve unapplied items.
Audit claim and payment data for accuracy, proper denial status, and correct payer assignment.
Validate reimbursement amounts against contracted fee schedules and expected payments.
Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services. Since 2019, we have served thousands of clients and are a fast-growing, fully remote team dedicated to parent-focused intervention and improving outcomes.
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.
Own HIPAA-compliant source-of-truth artifacts governing Medicare claims business rules.
Validate changes internally and communicate updates to external CMS stakeholders.
Bridge product and engineering by translating policy needs into clear requirements.
Nava is a consultancy and public benefit corporation working to make government services simple and effective. Since 2015, they have helped federal, state, and local agencies solve technology modernization challenges, and they are a remote-first team with a collaborative culture.
Manage client medical payment policies to ensure accuracy and compliance with CMS and payer guidelines.
Conduct periodic reviews and analyses of policy updates, coordinating with Medical Directors and presenting recommendations to clients.
Serve as the primary client liaison, addressing inquiries and maintaining detailed documentation of policy nuances.
Cotiviti is a healthcare data analytics company specializing in payment accuracy and medical policy management. The company fosters a collaborative remote culture and offers competitive benefits to support its team.
Understand plan formulary design and contracting potentials for client setups.
Analyze claims data to ensure accuracy of contract processing and provide recommendations for optimization.
Support sales, RFP, audits, and client operations as a subject matter expert.
Lumicera Health Services is an innovative specialty pharmacy solutions provider focused on transparency and stewardship. The company fosters a creative and diverse team environment.
Manage complex financial clearance activities for healthcare patients, ensuring accuracy and compliance.
Serve as a subject matter expert in insurance verification, payer requirements, and financial resolution processes.
Provide mentorship and training to team members while collaborating with clinical teams to improve patient access.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It uses technology to ensure fair and objective application reviews, though the final hiring decisions are made by the 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.
Identify opportunities to improve workflows, support automation, and scale billing processes.
Collaborate with internal teams and external EAP partners for accurate billing and payment processing.
Rula provides evidence-based mental healthcare, aiming to destigmatize and integrate mental health into overall well-being. They are a remote-first company hiring in most U.S. states, fostering a culture of inclusion and support.
Engage directly with clients to provide advanced analytical support for pricing consultations and AI model adoption.
Write and execute SQL and Python queries to analyze large datasets and evaluate submission performance.
Clearly communicate complex mathematical and AI concepts to non-technical client stakeholders.
Gradient AI revolutionizes Group Health and P&C insurance with AI-powered solutions that help insurers predict risk more accurately, improve profitability, and automate underwriting and claims. Backed by $56M in Series C funding and scaling rapidly since 2018, the company fosters a fun, team-oriented startup culture.
Analyze customer data and operational insights to identify trends and areas for improvement.
Partner with enterprise customers to understand goals, challenges, and success metrics.
Collaborate with cross-functional teams to ensure effective use of solutions and achieve desired outcomes.
This partner company enables healthcare organizations to adopt innovative technology solutions. They are a mission-driven organization focused on improving patient care delivery.
Validate accuracy of CPT, HCPCS, revenue codes, and billed line-item charges on outpatient and inpatient facility claims.
Apply CMS guidance, coding guidelines, and industry standards during claim review, including hospital bill audits and itemized bill reviews.
Prepare appeal responses using applicable coding guidance and maintain required certifications and continuing education.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve access to healthcare. They are a dynamic growing organization promoting a collaborative and innovative work environment.
Develop and maintain system pricing for health care claims.
Analyze contract financial performance and coordinate internal/external audits.
Provide routine and ad hoc reporting to support business decisions.
HCSC is a health insurance company dedicated to expanding access to high-quality, cost-effective health care. With over 80 years of experience, they foster a collaborative and inclusive culture that values employee development and diversity.
Perform advanced healthcare payment audits by analyzing claims data and identifying discrepancies.
Develop and improve audit concepts focused on payment accuracy and reimbursement policies.
Collaborate with audit, engineering, and business teams to ensure accurate findings and process improvements.
Jobgether is an AI-powered job matching platform that uses technology to connect candidates with roles. The company operates remotely and focuses on efficient, objective hiring processes.