Review and analyze insurance denials using EOBs, payer correspondence, and claims data to determine appropriate resolution strategies.
Differentiate between clinical and technical denials and identify required next steps for appeals or reprocessing.
Prepare and submit appeals using supporting documentation such as medical records, appeal letters, and clinical justification when necessary.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use automated technology to review applications and share top-fitting candidates directly with employers, ensuring a fair and efficient hiring process.
Build and maintain core VBC performance metrics across risk, quality, utilization, and cost domains.
Develop customer-facing analytics and dashboards surfacing actionable performance insights.
Analyze Medicare Advantage data to identify gaps and opportunities at multiple levels.
Counterpart Health is an AI-powered physician enablement platform delivering clinical insights to providers at the point of care. As a subsidiary of Clover Health, we have a remote-first culture with a focus on diversity and inclusion.
Shape and advance the organization's medical economics capabilities through leadership and statistical analyses.
Partner with cross-functional teams to validate claims data, improve data integrity, and enable sophisticated economic modeling.
Translate complex claims and utilization data into actionable recommendations for senior leadership.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered approach. They are a growing organization committed to improving patient outcomes and quality of life.
Direct AR and analytics teams to improve revenue cycle financial performance across multi-entity environments.
Bridge data-driven insights with operational support, partnering with RCM, Finance, HIM, IT, and executive leadership.
Manage daily billing/collection activities, mentor staff, and implement strategies to reduce AR and increase cash collections.
Ovation Healthcare strengthens independent community healthcare by providing support, guidance, and tech-enabled shared services. Partnering with 375+ hospitals across 47 states for over 45 years, the company fosters a collegial atmosphere of professionalism and teamwork.
Troubleshoot complex product and technical issues to determine severity and scope.
Manage escalated issues from Customer Support, Account Management, and Implementation teams.
Maintain customer ownership and leverage CRM tools like Salesforce to resolve inquiries.
Experian is a global data and technology company that powers opportunities for people and businesses worldwide. With 23,300 employees across 32 countries, we are a FTSE 100 company committed to innovation and inclusion.
Investigate and resolve health plan denials for coding-related issues, including rejections, down codes, bundling, modifiers, and level of service.
Generate appeals based on dispute reasons and contract terms specific to payors, including online reconsiderations and following payer guidelines.
Maintain working knowledge of workflows, systems, and tools used in the department, adhering to production and quality standards.
Ventra is a leading business solutions provider for facility-based physicians, focusing on Revenue Cycle Management. The company partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver data-driven solutions.
Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies.
Displays and analyzes data to identify trends and works collaboratively to develop a plan of action.
Northside Hospital is an award-winning, state-of-the-art healthcare provider that is continually growing in Atlanta and beyond. As a large healthcare organization, they offer opportunities for healthcare professionals to join a team focused on expanding quality and reach of care.
Own denials, rejections, and outstanding AR for our customers: Work the full recovery lifecycle from root cause diagnosis to resolution.
Pair deep RCM judgment with AI-native tooling: Use Joyful Health's platform to resolve claims at speed and scale, applying expertise where human judgment matters most.
Collaborate with Revenue Cycle Success Managers, RCM Center of Excellence, and Engineering teams to sharpen recovery work and feed product improvements.
Joyful Health is building the AI-powered financial operating system for healthcare practices, aiming to simplify financial operations so providers can focus on patient care. They just announced a $22M Series A led by CRV and investors including founders of MongoDB & KAYAK, and are a small, ambitious team with big goals.
Assist team on a smooth end-to-end billing process
Investigate, document, and follow up on denials and underpayments
Complete recurring work queues on a monthly basis
Omada Health is reverse engineering healthcare delivery, focusing on the space between doctor visits. They offer virtual-first models with human-led care teams, connected devices, and AI to support chronic conditions and have served over two million members across 2,000+ organizations.
Responsible for strategic and operational support through analysis of clinical, financial, and coding claims data.
Leverage abstraction and analysis of datasets to benchmark performance and identify areas for improvement in CDI, coding and provider documentation practices.
Play a key role in driving improvements in case mix index (CMI), risk adjustment, and departmental focus on identified trends.
Emory Healthcare is fueling professional journeys with better benefits, valuable resources, ongoing mentorship and leadership programs, and a supportive environment. They enable employees to reach new heights in their careers and be what they want to be.
Manage insurance account workflows and ensure accurate resolution of billing and reimbursement issues.
Investigate, resolve, and appeal insurance denials while documenting actions in compliance with standards.
Monitor aged accounts receivable and prioritize workloads to optimize collections and reduce outstanding balances.
Our partner is a healthcare services organization focused on revenue cycle management. They offer a collaborative and mission-driven environment with a comprehensive benefits package.
Analyze denied insurance claims and apply clinical reasoning to determine appeal merit.
Draft persuasive, medically sound appeal letters to recover denied revenue.
Collaborate with legal team to ensure appeals are compelling and complete.
Ternium specializes in resolving complex healthcare insurance claim denials and delays for hospitals. They have a dedicated, mission-driven team and value diversity and inclusion.
Own the full AR cycle: payment posting, cash reconciliation, aging management, and payer follow-up across district, health plan, and member inquiries.
Investigate and resolve complex claim denials and rejections, submit corrected claims and appeals, and drive systemic fixes to improve clean claim rates.
Serve as internal subject matter expert on payer requirements, billing regulations, and compliance standards, fielding escalations from clinical and operations teams.
Cartwheel is building a new kind of mental health program for kids that puts schools at the center. Backed by top investors, it has grown to serve more than fifty school districts across six states and is driven by a mission to help millions of students experience joy.
Ensures accuracy and timeliness of patient financial records, including payment posting, insurance follow-up, and revenue integrity.
Monitors work queues, resolves payer discrepancies, and supports provider enrollment and revalidation activities.
Assists with charge review and correction using Epic workflows to improve reimbursement accuracy and cash flow.
This position is listed on behalf of a partner company that manages all applications and next steps for a healthcare revenue cycle environment. The role supports multiple Patient Financial Services functions within a large, process-driven healthcare organization.
Manage end-to-end Performance Guarantee lifecycle for strategic accounts, including monitoring, metric validation, and contract tracking.
Execute recovery analytics to mitigate financial risk and build data pipelines and Looker dashboards for specialized metrics.
Support RFPs and renewals with scenario modeling and risk quantification, and serve as technical lead in client discussions.
Included Health delivers integrated virtual care and navigation, breaking down barriers to provide high-quality care for everyone. It offers guidance, advocacy, and access to personalized virtual and in-person care.
Investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis and interviews.
Analyze information, report findings, and recommend settlements or denials while supporting legal proceedings.
Conduct training on fraud detection and maintain knowledge of relevant laws and regulations.
Cotiviti is a healthcare analytics company that helps clients reduce costs and improve outcomes through data-driven insights. As a global leader in payment accuracy and network performance, Cotiviti fosters a collaborative and inclusive culture.
Must have at least 5 years' RN experience with current licensure, a bachelor's degree or equivalent, and at least 1 year of leadership with direct reports.
Responsible for overseeing RN denials management specialists, pre-bill utilization reviews, payer calls, workflow optimization, and collaboration with internal RCM teams.
Blends clinical expertise with revenue cycle management to protect the organization's bottom line, decrease A/R, and ensure compliance.
Banner Health is one of the largest nonprofit health care systems in the country, providing hospital services, primary care, research, and physician practices across multiple states. With 31 facilities and a focus on innovation, they recently earned Great Place To Work certification, reflecting their investment in employee happiness and fulfillment.
Serve as the main point of contact for providers, resolving escalated issues and maintaining positive relationships.
Manage internal projects to improve provider experience, including education on best practices and policies.
Use data analysis and tools like Excel and Salesforce to investigate issues and reduce provider abrasion.
Clover Health provides high-quality, affordable healthcare plans for America's seniors by leveraging data and technology through the Clover Assistant. The company is a mission-driven, remote-first organization with a focus on diversity and inclusion, employing a team of passionate professionals.
Lead and supervise application analysts responsible for billing and claims systems, ensuring design, build, testing, and support.
Oversee team workload, change control, and issue resolution while serving as an escalation point for production issues.
Partner with operational stakeholders to refine revenue cycle workflows and drive continuous improvement.
Jobgether is an AI-powered job matching platform that helps candidates connect with hiring companies. The company focuses on fair and efficient recruitment processes, leveraging technology to review applications and identify top-fitting candidates.
Resolve aged claims and appeals via payer portals & outbound phone calls.
Identify non-payment trends and escalate groups of claims to the Dispute Resolution teams.
Propose solutions and collaborate cross-functionally with the Denials Management Steering Committee.
CareDx, Inc. is a precision medicine solutions company focused on healthcare solutions for transplant patients. They offer products, testing services, and digital healthcare solutions. They are the leading provider of genomics-based information for transplant patients.