Source Job

• Ensure adherence to payer requirements and internal compliance standards.
• Support audit readiness, reduce denials, and improve claim resolution.
• Maintain payer setup and readiness including fee schedules.

Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services, serving thousands of clients.

• Provides policy expertise related to systems or products.
• Communicates Medicaid program insight to UX researchers and designers.
• Analyzes laws and policy documents and explains their impact.

A1M Solutions is a woman-owned small business focused on providing value to customers, employees, partners, and the community, while remaining aligned to its guiding principles. A1M’s mission is to preserve and improve government healthcare programs for underserved people in the United States, focusing on projects with nation-wide impact at the intersection of policy, data, and user experience design.

• Serve as a key team member across multiple projects on topics that include payer strategy, process improvement, compliance, quality, and evidence generation.
• Conduct qualitative and quantitative research on a diverse array of healthcare issues.
• Translate research into actionable business insights for health plans, including through strategic roadmaps, presentations, white papers, and workshops.

Avalere Health ensures every patient is identified, treated, supported, and cared for. Their Advisory, Medical, and Marketing teams forge unconventional connections, building a future where healthcare is not a barrier and no patient is left behind. The company has major city hubs in London, Manchester, Washington, D.C., and New York, and smaller offices globally.

• Ensure timely and accurate payment of medical claims, following health plan policies and procedures.
• Maintain accurate and up-to-date notes of all claims processed.
• Process appeals and disputes by gathering and verifying claim information and communicating outcomes.

Sana Benefits aims to create an easy healthcare experience. They focus on providing seamless care and affordable benefits to small businesses.

• Process transactions on insurance accounts and interact with insurance companies.
• Communicate with staff and third-party customers to ensure accurate processing.
• Prioritize accounts to maximize aged AR resolution, and research documentation.

Oregon Health & Science University values a diverse and culturally competent workforce. They are proud of their commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.

Conducts medium- to high-complexity investigations into alleged fraud, waste and abuse. Assists with the administration of Program Integrity activities. Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities.

Central California Alliance for Health is an award-winning regional Medi-Cal managed care plan providing health insurance to residents in multiple counties.

Review and accurately post insurance and patient payments. Resolve auto-posted ERA errors on a daily basis. Research and follow up on outstanding insurance claims.

Prompt is revolutionizing healthcare by delivering highly automated and modern software to rehab therapy businesses, their teams, and the patients they serve.

• Resolves delinquent payment issues of complex accounts.
• Investigates patient account information, medical records and bills, billing and reimbursement regulations.
• Analyzes each account to optimize reimbursement and remove barriers to processing claims.

Legacy Health is dedicated to good health for its people, patients, communities, and the world, emphasizing doing the right thing. They foster an inclusive environment where everyone can grow and succeed, committed to equal opportunity.

• The Director, MSSP Quality will lead cross-functional operational initiatives across Provider Networks and Product to ensure comprehensive data integrity and optimal performance in Quality reporting.
• The Director will be responsible for managing and resolving field queries, preparing comprehensive reporting for executive and practice leadership, and formulating strategic initiatives for MSSP Quality programs across the organization.
• The role requires strong leadership capabilities, analytical experience, and the ability to collaborate effectively with cross-functional teams while translating complex quality data into actionable insights that drive organizational excellence in MSSP Quality performance.

Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.

• Lead payer credentialing and re-credentialing processes for healthcare providers.
• Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
• Oversee payer enrollments, manage the payer credentialing team, maintain data accuracy, and streamline provider onboarding.

Theoria Medical provides comprehensive medical group and technology solutions to serve patients across the care continuum, with an emphasis on post-acute and primary care. They aim to improve the quality of care delivered, refine facility processes, and enhance critical relationships, serving facilities across the United States.

• Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
• Audit internal provider data against database records to ensure 100% accuracy before submission.
• Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.

• Manage relationships with payment providers, PSPs, payment orchestrators, and local payment partners.
• Coordinate with partners and internal teams to resolve issues efficiently.
• Act as the internal owner for payments-related compliance topics.

Pixery is a global tech company building innovative apps for next-generation mobile creatives. Our video apps reach more than 100 million users worldwide and they value transparency, shared ownership, and open communication.

• Conduct timely and accurate eligibility checks and benefit investigations through payer portals and phone outreach to ensure claims are submitted correctly from the start
• Enter and monitor DME claims across multiple platforms, troubleshoot billing issues, and proactively follow up to reduce denials and accelerate reimbursement
• Analyze explanation of benefits (EOBs) for errors, missing payments, or misapplied patient responsibility, then determine and execute the correct resolution path

Babylist is the leading registry, e-commerce, and content platform for growing families helping parents feel confident, connected, and cared for at every step. It has over $1 billion in annual GMV, and more than $500 million in 2024 revenue and is reshaping the $320 billion baby product industry.

Discuss insurance coverage with patients and explain financial obligations. Identify and enroll eligible patients in financial aid programs. Coordinate payment arrangements pre- and post-treatment and accurately document communications.

IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis.

• Develop, implement, and monitor systems that ensure compliance with Medicare and other payor documentation guidelines.
• Analyze physician practices to identify charge opportunities and ensure all billable services are captured.
• Perform regular audits to ensure compliance with coding and documentation guidelines and provide feedback to physicians.

Legacy Health is committed to fostering an inclusive environment where everyone can grow and succeed. They are an equal opportunity employer that prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants.

• Perform daily revenue integrity audits and charge reconciliation.
• Monitor patient board and review census and discharges.
• Collaborate with care providers to resolve missing documentation.

UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers and nearly 200 physician practice locations.

The Revenue Analytics Manager leads analysis and reporting to improve financial health, focused on revenue optimization. The role involves collaborating with teams to model the financial impact of contracts and payment methodologies. This role also requires creating financial reports and analyses that communicate key drivers of revenue performance to stakeholders.

UChicago Medicine provides superior healthcare with compassion, always mindful that each patient is a person, an individual.

• Own the end-to-end strategy for insurance methodologies across lines.
• Define excellence for our insurance assessment frameworks in terms of user value.
• Shape the roadmap for proprietary insurance metrics and how they surface in rankings and data products.

Forbes Advisor aims to help readers turn their aspirations into reality by providing trusted advice and guidance for informed decision-making. They are an experienced team of industry experts with decades of experience across various departments and global coverage in consumer-related topics.

• Multi-task position covering main functions of the Central Business Office.
• Accurately handle at least one unit function of the Central Business Office.
• Monitor billing errors and claim/line item rejections.

Piedmont Healthcare is a company in the healthcare sector, though further details are not given in the job description.

• Provides accurate payment posting to accounts and analyzes accounts.
• Identifies issues with payments and reconciles accounts for credits.
• Monitors accounts receivable and communicates payment denials.

Gen4 is committed to providing an incredible patient experience. They foster a doctor-centric organization with a focus on culture, high performance, and growth, and seek individuals excited to be part of their growing company.