Manage provider data across health plans, including demographics, reimbursement rates, contracts, and key operational information.
Coordinate provider audits, credentialing activities, service and relationship processes, and contract management systems.
Oversee daily priorities for administrative teams and external vendors, using data analysis to improve provider network operations.
This healthcare organization supports provider network operations across health plans. They offer a collaborative, deadline-driven environment with a focus on independent work and analytical skills.
Provides administrative support to clinical teams including building medical management records and managing authorizations.
Conducts fax and telephonic outreach to members and providers for status updates and engagement.
Supports compliance monitoring and documentation in the medical management system.
Capital Blue Cross is a health insurance provider dedicated to improving the health and well-being of its members and communities. They are recognized as one of the "Best Places to Work in PA" with a culture focused on support, flexibility, and community involvement.
Maintain provider rosters and demographic data in internal systems.
Process provider requests, collect documentation, and prepare contract agreements.
Flag workflow issues and help audit provider-facing materials.
Sana is a health plan solution for small and midsize businesses, offering integrated primary care and affordable benefits. Founded in 2017, Sana is remote-first with a fully distributed team across the U.S., valuing curiosity, ownership, and speed.
Adjudicate healthcare claims based on client-specified guidelines and determine appropriate payment for services.
Meet productivity, financial accuracy, and procedural standards while mentoring junior team members.
Collaborate on special projects including process documentation, training, quality audits, and surge activity.
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, fostering a collaborative and growth-oriented culture.
Prepare and review credentialing and recredentialing applications, provider updates, termination letters, and TIN change documents.
Conduct biweekly follow-up with payers, track application progress, and maintain detailed records in internal systems and dashboards.
Support team projects such as new provider onboarding, payer roster updates, and quality reviews while protecting confidential information.
Specialty Dental Brands is a dental support organization that partners with pediatric dentistry, orthodontics, and oral surgery practices across the country, empowering teams with technology, resources, and support. The company values a people-first culture, collaboration, continuous learning, and creating positive experiences for providers, practices, and employees.
Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.
Review and verify assigned medical codes for accuracy.
Enter demographic and insurance information into the billing system.
Respond to inquiries and assist with audits to ensure accurate billing.
Virtual Firm LLC provides medical data entry, coding, and billing services for healthcare providers. The company operates as a virtual firm, offering remote work opportunities and an entry-level friendly environment.
Assigns ICD-9 and/or ICD-10 codes to inpatient encounters with the highest accuracy following official coding guidelines.
Works closely with physicians, clinical documentation specialists, quality, and patient finance teams to ensure accurate DRG assignment and data extraction.
Plays a key role in billing, research, regulatory compliance, and reporting to support patient acuity and quality outcomes.
Emory Healthcare is a comprehensive health system providing patient care, research, and education across multiple hospitals and clinics. They foster a supportive culture with mentorship, leadership programs, and a focus on professional growth, serving a large and diverse workforce.
Process incoming medical referrals, enter accurate data into medical management systems, and assign appropriate healthcare providers.
Review referrals for benefits and medical necessity, escalate sensitive cases for clinical assessment, and apply ICD-10 and CPT codes.
Communicate with military treatment facilities and civilian providers, respond to inquiries, and manage referral tasks within established timelines.
This position is listed on behalf of a partner company that manages all applications and next steps. The company supports healthcare service delivery by ensuring medical referrals are processed accurately and efficiently within a structured, collaborative remote team.
Manage end-to-end facility credentialing and privileging for providers across SNFs nationwide.
Prepare and track credentialing applications, facility packets, and compliance files.
Coordinate with facilities to resolve credentialing, access, and EMR issues in a timely manner.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for healthcare facilities, leveraging a global network to connect clients with qualified professionals. The company offers a flexible remote work environment where employees collaborate with an international team and contribute to a growing business.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Complete credentialing and re-credentialing applications for physicians, ancillary providers, and facilities with third-party payers and governmental programs.
Partner with client liaisons and payers to manage enrollment status, follow up on applications, and communicate updates to providers and clients.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies across the US. The firm is known for its client-centered, people-first culture and commitment to diversity, learning, and well-being.
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.
Execute day-to-day provider enrollment, credentialing, and licensing tasks under the guidance of Specialists and Team Leads.
Accurately input, maintain, and update provider data across credentialing databases and internal systems.
Identify and escalate issues, discrepancies, or complex cases to the appropriate team member in a timely manner.
Allara is a comprehensive women’s health provider specializing in expert, longitudinal care for hormonal, metabolic, and reproductive health. It is one of the fastest-growing women’s health platforms in the U.S., with a mission-driven, collaborative culture focused on bridging gaps in healthcare.
Review and configure executed provider contracts and amendments for completeness and accuracy.
Coordinate with cross-functional teams to resolve issues and manage downstream dependencies.
Manage an assigned caseload while maintaining service delivery, productivity, and quality standards.
Oscar is a health insurance company built on a full-stack technology platform, focused on serving its members. The company values collaboration and innovation, with a team dedicated to transforming healthcare.
Manage accident-related accounts from intake to resolution, coordinating no-fault and liability benefits.
Submit claims to carriers, maintain accurate records in AcciClaim, and monitor insurance portals.
Work independently, set priorities, and communicate professionally with patients and adjusters.
Revecore helps hospitals recover revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, the company combines specialized expertise with proprietary technology and fosters a supportive, innovative workplace.
Assign ICD-10 and CPT/HCPCS codes to patient encounters based on medical documentation.
Analyze medical records to extract pertinent coding information.
Ensure compliance with AMA, CMS, and other regulatory coding guidelines.
Mass General Brigham is a not-for-profit integrated health care system supporting patient care, research, teaching, and community service. We believe high-performing teams drive groundbreaking medical discoveries and foster a welcoming community focused on changing lives.
Review inpatient and outpatient records and assign accurate ICD-10, CPT, and HCPCS codes.
Maintain a minimum coding accuracy of 95% while meeting turnaround and quality standards.
Work fully remotely within the US supporting multiple medical facilities.
This position is listed on behalf of a partner company within a large healthcare network. They focus on health information management and clinical coding accuracy, offering a fully remote environment.
Monitor clearinghouse portals and resolve rejected medical claims daily.
Investigate rejection causes including coding errors and eligibility issues.
Correct claim information and resubmit to insurance payers for reimbursement.
Our partner is a healthcare revenue cycle management company focused on optimizing medical claims processing for providers. They offer a collaborative, inclusive work culture with opportunities for professional growth in a remote environment.