Review, investigate, and appeal denied hospital insurance claims using clinical documentation and payer policies.
Develop evidence-based appeal letters addressing medical necessity, level-of-care, and charge discrepancies.
Collaborate with nursing, revenue integrity, and financial teams to resolve denials and prevent future rejections.
This partner company is a healthcare system that provides hospital services and focuses on revenue integrity. It supports fully remote work and values clinical expertise, collaboration, and financial sustainability.
Coordinate denial and appeal follow-up activities to ensure timely resolution of insurance denials and appeals.
Investigate payment issues with insurance carriers, maintain tracking systems, and document follow-up actions.
Analyze performance data and collaborate with revenue integrity teams to improve billing accuracy and recovery.
This healthcare organization specializes in pediatric care and research, focusing on operational excellence. The team fosters a collaborative culture centered on quality, accountability, and continuous improvement.
Conduct clinical reviews of inpatient admissions and continued stays using approved medical necessity criteria.
Collaborate with physicians, care managers, and payer teams to resolve utilization concerns and prevent denials.
Support quality improvement initiatives, maintain accurate documentation, and communicate review outcomes effectively.
This role is with a partner company focused on healthcare utilization management, helping hospitals improve patient outcomes and ensure appropriate resource use. The team operates as a distributed remote group supporting care coordination, revenue integrity, and clinical compliance.
Analyze hospital claims to identify discrepancies between expected and actual insurance reimbursements.
Investigate underpayments and payment variances by examining coding errors, billing discrepancies, and payer policies.
Collaborate with insurance carriers and internal stakeholders to resolve billing issues and improve revenue recovery outcomes.
This partner company specializes in healthcare revenue integrity, helping hospitals recover appropriate reimbursement for services. The team fosters a collaborative, inclusive culture focused on continuous improvement and professional development.
Conduct clinical and billing reviews of claims, itemized bills, and UB-04 forms to ensure accuracy.
Perform utilization reviews to assess medical necessity and validate charges against policies.
Mentor reviewers, meet productivity targets, and maintain active RN licensure with CEUs.
Our partner is a healthcare services company that conducts medical claims and utilization reviews to ensure accurate billing and appropriate care. They offer a collaborative, quality-focused remote environment with opportunities for professional development.
Perform concurrent medical record reviews on nursing units to clarify patient documentation.
Prompt physicians to resolve missing, unclear, or conflicting documentation for appropriate reimbursement.
Provide education to patient care providers on clinical documentation standards and coding requirements.
Virginia Mason Franciscan Health provides a full spectrum of health care services across the Puget Sound region, with a legacy of compassionate care and innovation. With 10 hospitals and nearly 300 care sites, the organization is dedicated to healing the whole person through rigorous research, education, and collaboration.
Resolve denied claims by reviewing supporting documentation, calculating benefits due, and composing appeal letters.
Analyze claims to determine validity of denial/recovery options and draft convincing correspondence to effect reimbursement.
Build relationships with insurance carriers, patients, attorneys, and employers while documenting all actions to resolution.
Xsolis is an AI-driven technology company reducing administrative waste in healthcare by enabling smarter collaboration between providers and payers. Recognized on the Inc. 5000 and Deloitte Technology Fast 500 lists, it is one of the fastest-growing privately-held companies in North America with a passionate, fast-moving culture.
Review inpatient medical records to validate DRG coding accuracy.
Apply clinical judgment to identify discrepancies, coding errors, and overpayments.
Document evidence-based audit findings and meet quality standards.
The company specializes in healthcare claims auditing and analytics, improving accuracy and consistency in payments. It is a collaborative, fully remote environment that values precision, teamwork, and continuous improvement.
Analyze and summarize medical records, highlighting relevant clinical findings for attorneys.
Prepare medical chronologies and long-term care assessments to support case evaluations.
Provide objective, evidence-based medical insights and coordinate with expert witnesses.
The partner company provides specialized legal nurse consulting services to attorneys, analyzing medical records and supporting injury-related cases. This role offers flexible, part-time contract work in a fully remote environment.
Investigate claim denials, navigate evolving payer requirements, and ensure complex claims are prioritized and resolved accurately.
Partner with cross-functional teams to identify operational and denial trends, optimizing workflows and claim outcomes.
Act as the pod’s go-to expert for payer workflows, claim resolutions, and best practices, supporting new-hire onboarding and team performance.
Rula is a mental healthcare company dedicated to providing quality, evidence-based care and reducing stigma around mental health. It is a remote-first company with a focus on inclusion, employee well-being, and making mental healthcare work for everyone.
Manage accounts receivable, including analysis of aged AR and identification of root cause issues.
Investigate, resolve, and appeal insurance claim denials, contacting payer representatives as needed.
Collaborate with internal teams and care center staff to drive optimal revenue cycle performance.
Privia Health is a technology-driven physician enablement company that partners with medical groups and health systems to optimize practices and improve patient experiences. It is led by top industry talent and physician leadership with a focus on scalable operations and cloud-based technology.
Review and abstract medical records for new patients, ensuring charts are complete and accurate before initial appointments.
Analyze medical documentation to identify relevant clinical information and serve as a resource for moderately complex cases.
Collaborate with intake leadership to support departmental goals, quality standards, and continuous improvement.
The hiring company supports healthcare teams by providing accurate medical record abstraction and patient intake services. It fosters a remote, collaborative culture that values professional development and meaningful patient impact.
Manage and triage patient vital signs remotely, using motivational interviewing to drive positive health behavior changes.
Perform monthly wellness calls with patients, collaborating with care teams to set patient-centric goals.
Escalate urgent care needs appropriately and meet program engagement metrics in a remote MST-based role.
Vivo Care is building a future where care is continuous, personal, and connected, challenging the status quo in healthcare. We are a fast-growing startup where everyone has a voice, fostering a culture of inclusion, collaboration, and innovation.
Manage the full revenue cycle from patient registration through claims resolution.
Accurately submit and track medical claims to various insurance payers.
Perform accounts receivable follow-up, identifying and resolving denied, underpaid, or unpaid claims.
Allara is a comprehensive women's health provider that offers expert, longitudinal care for hormonal, metabolic, and reproductive conditions. It is one of the fastest-growing women's health platforms in the U.S., trusted by thousands of women nationwide.
Process and submit claims to health plans accurately and on time, maintaining momentum through the billing cycle.
Investigate denied and rejected claims, identify root causes, correct, and resubmit; flag recurring patterns to fix issues at the source.
Monitor claim status, follow up on reimbursement, support reporting and month-end close, and partner with finance, product, and engineering teams.
Foodsmart is a leading Foodcare platform that delivers personalized nutrition care and food benefits to improve health outcomes while lowering healthcare costs. With over 3 million members and backed by a $200 million investment, the company is mission-driven to make nutritious food accessible and affordable for everyone.
Acts as a subject matter expert in Revenue Integrity products including DRG, DRGV, and Medical Necessity Denials.
Defines departmental goals, financial targets, and KPIs while overseeing quality and productivity metrics.
Leads a high-performing team through hiring, training, coaching, and performance monitoring.
EnableComp provides revenue integrity solutions for healthcare providers, specializing in DRG validation, medical necessity denials, and revenue recovery. The company values leadership, operational excellence, and cross-functional collaboration in a remote-first environment.
Leads enterprise authorization operations with direct impact on revenue protection, patient access, and reimbursement performance.
Manages a team responsible for insurance verification, pre-authorization, and timely processing of assigned services.
Collaborates with billing, registration, revenue cycle, clinical, and administrative teams to reduce preventable payment denials.
The partner company is a healthcare organization focused on revenue protection, patient access, and reimbursement performance. They provide a collaborative and mission-driven environment for teams working across complex healthcare operations.
Research denied claims and complete portal inquiries or outbound calls to insurance reps to identify root causes.
Resubmit corrected claims using CMS 1500 knowledge and draft appeals in line with medical policies.
Prioritize denials using the internal Claim Prio Model and flag system improvements to reduce denial inflow.
Grow Therapy is a mental health care platform operating a three-sided marketplace that connects providers, insurance payors, and patients to expand access to quality care. Backed by over $328M in funding and a $3B valuation, the company fosters an ambitious, ownership-driven culture.
Perform prospective, concurrent, and retrospective utilization review to ensure medical necessity and appropriate level of care.
Research and respond to appeals, coordinate discharge planning, and analyze care patterns.
Collaborate with providers and internal teams to resolve benefit and eligibility issues.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, helping them modernize operations and compete effectively. The company is expanding and investing in its people, offering opportunities to shape the future of healthcare technology.