Partner with business stakeholders across HR, Payroll, Benefits, Sales, and Client Services to elicit, analyze, and document business and functional requirements.
Translate business requirements into clear user stories, process flows, use cases, and functional specifications for technology delivery teams.
Provide Tier 2 application support by triaging, diagnosing, and resolving system issues; escalate complex incidents to Tier 3 or vendors as appropriate.
ExtensisHR is a Professional Employer Organization (PEO) in the U.S. with client employees in all fifty states. They deliver on their brand promise of helping organizations succeed through a people-first approach in solving customer’s ever-evolving HR needs.
Responsible for supporting the implementation, maintenance, analysis, and quality assurance of ConnectiveRx pharmaceutical affordability programs.
Accountable for program set-ups and maintenance, performs quality control on program setups and updates, and investigates adjudication outcomes and data discrepancies.
Applies business rules consistently to ensure operational accuracy and program integrity and works independently on routine tasks.
ConnectiveRx helps pharmaceutical manufacturers untangle the complex prescription process. They bring together diverse voices to allow patients to build trusting relationships with their medication brands. ConnectiveRx offers comprehensive benefits including medical, dental, vision, life, and disability insurance.
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.
Supports Medical Policy Directors (MPD) through various aspects of the New Policy processes.
Performs multi-faceted data and report analytics to provide accurate client or policy information.
Researches and examines client questions and drafts accurate responses.
Cotiviti provides payment accuracy and analytics-driven healthcare solutions. They have a large team, and cultivate an inclusive and equitable environment for all employees.
Manage complex provider roster creation, submission, and record reconciliation for multiple payers.
Oversee resolution of moderate-scope issues by prioritizing tasks and escalating issues with solutions.
Proactively identify areas for operational improvement and efficiency enhancement.
Aledade empowers independent primary care practices to deliver better patient 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.
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.
Drive the improvement and evolution of business operations by understanding the company's continuously changing needs.
Coordinate and facilitate cross-functional stakeholders in analyzing business processes and recommending solutions.
Manage communication and status updates of inflight work and initiatives to keep business stakeholders informed.
symplr is revolutionizing healthcare operations with a first-of-its-kind platform that drives effective, efficient, and connected workflows. They are a remote-first company with employees working across the United States, India, and the Netherlands and they value teamwork, championing customers, and leading through equality and integrity.
Participate in end-to-end implementation activities.
Develop an understanding of Experian Health's product suite and apply best‑practice workflows.
Facilitate requirements gathering, workflow mapping, configuration reviews, and user acceptance testing.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange, they have a team of 23,300 people across 32 countries.
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.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Champion incremental innovation and improvement of payment products based on the product vision and roadmap, ensuring a scalable, API-driven architecture with strong security and compliance.
Collaborate with Product Managers, Development, and cross-functional teams to manage backlogs, prioritize features, and translate business needs into user stories and acceptance criteria.
Participate in Agile ceremonies, support product launches, gather user feedback, and use SQL for data exploration to ensure product features comply with healthcare regulations like HIPAA.
Experian is a global data and technology company that uses data, analytics, and software to power opportunities for people and businesses, such as redefining lending and preventing fraud across industries like financial services and healthcare. It is a large FTSE 100 company with a team of approximately 23,300 people operating across 32 countries, fostering a people-first culture focused on inclusion and work/life balance.
Manage data of all manufacturers, suppliers, or group purchasing organization (GPO) clients.
Monthly accounting and reconciliation of financial activities of current and future contracts.
Assist in contract implementation process and development.
Sodexo creates a better everyday for everyone and builds a better life for all. They improve the quality of life for those they serve and contribute to the economic, social, and environmental progress in the communities where they operate. Sodexo values employees, embracing diversity and inclusion as core values.
Reconciles actual spend with payor 'Post Bundle' period end.
Hackensack Meridian Health helps patients live better, healthier lives. With a culture rooted in connection and collaboration, employees are team members and are supported to succeed.
Analyze healthcare data and generate actionable insights.
Support Prompt's enterprise clients on the Prompt BI platform.
Spearhead the sales efforts for the Prompt BI platform.
Prompt is transforming healthcare by providing highly automated software to rehabilitation therapy businesses. They are the fastest-growing company in this sector and seek to be the new standard in healthcare technology.
Own the intake and discovery process for internal data initiatives.
Translate business requirements into clear, dev-ready documentation.
Identify gaps, conflicts, or risks in requirements early and resolve them.
Mitratech builds products that simplify operations in the Legal, Risk, Compliance, and HR functions. They are a team that thrives in an ecosystem that supports individual excellence and takes pride in its diverse and inclusive work culture.
Analyze and document business and technical requirements for client migrations.
Support configuration of claims systems including benefits, eligibility, accumulators, and workflows to match client operational needs.
Define and validate data operations endpoints, file feeds, and integrations to ensure accurate data flow between systems.
Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes.
Support medical policy functions by providing medical coding and system configuration support.
Perform coding analyses and utilization reporting to recommend medical policy updates.
Participate in cross-functional meetings to align with enterprise strategic priorities.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. Motivated by the well-being of members, they are committed to service, sustainability and innovation.
Collaborate with business partners to gather business reporting and analytics requirements.
Understand and validate the accuracy and quality of the data.
Utilize visualization tools to design and create analytics dashboards and operational reports.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and quality of life by delaying disease progression and shifting care to the home.
Manage the provider data ticketing queue, ensuring timely resolution of requests.
Partner with team members to obtain required data elements and validate completeness.
Identify and implement opportunities to streamline provider data structure and workflows.
Curana Health is committed to radically improving the health, happiness, and dignity of older adults. They serve 200,000+ seniors in 1,500+ communities across 32 states, with over 1,000 clinicians, care coordinators, analysts and professionals.
Support external customers with analyzing current business processes, developing business requirements, and documenting management processes.
Collaborate with customers to facilitate structured discussions, refine business processes, and decompose complex requirements.
Map requirements to CGI’s Momentum Financials to determine which needs are met through configuration.
Ibility, founded in early 2021, is a Service-Disabled Veteran-Owned Small Business and a Woman-Owned Small Business, headquartered in Gaithersburg, MD. The team is fun, passionate, bold, and creative and lives its mission every day – to inspire people, create cool stuff, and make a lasting impact on the world!