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.
Prepare and file mortgage insurance claims, reconciling advances and validating supporting documents.
Maintain clear records and reports for management, assist with updating workstations, and track claim payments.
Conduct research, manage a task queue, and communicate effectively to work independently and meet deadlines.
LoanCare is a leading full-service mortgage loan subservicer for banks, credit unions, and other financial institutions, supporting over 1.8 million loans. Backed by Fortune 500 company Fidelity National Financial, it offers a culture built on integrity, innovation, and collaboration, providing resources for employee growth and flexibility.
Evaluates medical records to provide clinical and surgical abstraction for complex professional services, ensuring coding accuracy and compliance with national guidelines.
Consults with medical providers to clarify record information and accurately code diagnostic and procedural data using ICD-10-CM and CPT-4.
Works independently in a remote setting, utilizing coding software to maintain productivity and quality standards while supporting department projects and validation edits.
Banner Health is one of the largest nonprofit health care systems in the country, providing hospital services, primary care, research, and more across its network. It is a Great Place To Work® Certified organization with a large, skilled workforce committed to patient care and employee wellbeing.
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.
Build caring connections with every member by always leading with empathy, patience, and respect, ensuring members feel heard, supported, and valued.
Own each member interaction end-to-end, taking accountability to resolve inquiries during the initial contact and ensuring clear follow-through when additional steps are required.
Accurately respond to member inquiries regarding benefits, eligibility, services, policies, and procedures in a clear, confident, and member-friendly manner.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and the chronically ill. It is a fast-growing company with a team passionate about transforming lives through high-quality, low-cost care.
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.
Accurately code diagnoses, procedures, and other services to ensure medical records and billing are accurate.
Work with providers to ensure documentation is clear and complete, resulting in accurate coding.
Review all claim edits and correct errors in a timely fashion, coding for practice and hospital charges for all departments supported by the Professional Billing Office.
ProMedica is a mission-driven, not-for-profit health care organization that provides acute and ambulatory care, a dental plan, and academic business lines across nine states. The organization operates 10 hospitals and employs over 1,300 healthcare providers through ProMedica Physicians, with a culture committed to improving health and well-being, earning national recognition for clinical excellence.
Performs utilization review to determine medical necessity criteria compliance and facilitates resolution of escalated cases.
Collaborates with clients and physician reviewers, ensuring adherence to all HIPAA, state, federal, and regulatory standards like URAC & NCQA.
Utilizes various computer systems to manage cases, engages in provider communication, and participates in quality management programs while prioritizing independent work.
WNS, part of Capgemini, is an AI-powered leader in intelligent operations and transformation, serving over 700 clients across industries like Healthcare and Financial Services. It is a large global company with over 66,000 employees, combining deep domain expertise with AI platforms to create lasting business value.
Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
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. They work with over 660,000 providers and handle over 12 million prior authorization requests annually. The Coherenauts who succeed here are empathetic teammates who are candid, kind, caring, and embody their core values and principles.
Develop and maintain standard operating procedures and conduct training for revenue cycle teams to uphold best practices.
Perform audits on payer payments and fee schedules to ensure accurate reimbursement and identify denial trends affecting revenue.
Manage multiple priorities including special projects, Salesforce cases, and process documentation to support key performance goals.
Privia Health is a national physician enablement company that uses technology and scalable operations to help medical groups deliver high-value care in-person and virtually. The company, led by top talent and physician leaders, has a cloud-based platform focused on improving patient outcomes and provider well-being.
Deliver an outstanding customer experience by supporting inquiries across phone, email, text, and chat.
Manage high-complexity insurance workflows and inbound support requests to collect documentation.
Partner with clinical, scheduling, and operations teams to ensure accurate treatment plan alignment and continuity of care.
Expressable is a virtual speech therapy practice that aims to transform care delivery and expand access to high-quality services. Since 2019, they serve thousands of clients with a focus on parent-focused intervention and an e-learning platform with home-based learning modules.
Act as the first contact for new patients, discussing services with a supportive approach and coordinating patient/provider matching.
Conduct insurance eligibility verification and update patient charts with benefit information like copay and deductible.
Manage patient intake via phone, email, and text, schedule evaluations, and handle tasks like waitlist management and processing referrals.
Rivia Mind is a psychiatrist-owned mental health practice providing compassionate, science-based care through virtual and hybrid appointments across multiple US states. The company cultivates a collegial, growth-oriented culture rooted in shared values, curiosity, and authentic connection.
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.
Investigates claims using internal and external resources, analyzing reports and researching past claim activity to make damage and loss assessments.
Determines policy coverage through analysis of investigation data and policy terms, establishes claim reserves, and negotiates settlements within authority limits.
Maintains accurate claim file documentation throughout the life cycle of cases and alerts leadership to potential fraud or subrogation issues.
Liberty Mutual is a diversified global insurer and the third-largest property and casualty insurer in the United States. The company fosters an inclusive culture where everyone feels valued and can thrive, supported by comprehensive benefits and a commitment to professional development within a large corporate environment.
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.
Own and execute a new sales strategy for Pharmacy Claim Editing solutions within an assigned US territory.
Prospect, qualify, and close new opportunities with health plans, PBMs, TPAs, and self-funded plan administrators.
Develop and maintain senior-level relationships with pharmacy, claims, finance, and procurement leaders.
Cotiviti provides payment accuracy and analytics solutions for healthcare payers. The company is a growing organization offering competitive benefits and a remote work environment.
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.
Answer calls and resolve questions, routing to appropriate departments.
Complete documentation in EMR and marketing systems, including initial prescreening.
Schedule new and returning patients and complete follow-up duties.
Pyramid Healthcare provides addiction treatment, mental health recovery, and eating disorder treatment. They focus on client-centered care and offer supportive environments that help patients overcome life’s challenges.
Help potential customers navigate the online shopping experience and find suitable health insurance quotes.
Resolve administrative and billing questions with urgency and clarity, turning stressful questions into seamless resolutions.
Use industry-leading support tools and CRMs to document interactions and propose product/process improvements.
SimplyInsured aims to eliminate the fear associated with health insurance for small business owners by making it transparent and accessible. Born in Y-Combinator and backed by top-tier investors like Bessemer Venture Partners , SimplyInsured is disrupting a convoluted industry.
Conducting collection activity on appealed claims by contacting government agencies and third party payers.
Requesting additional information from Patients, Medical Records, and others as needed.
Reviewing contracts and identifying billing or coding issues and requesting re-bills, secondary billing, or corrected bills as needed.
Sutherland helps strengthen brands by improving customer experiences. They're a global company with nearly 40,000 employees across over 100 countries, focusing on customer care and delivering extraordinary service.