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.
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.
Manage the full revenue cycle from patient registration through claims resolution.
Accurately submit and track medical claims to various insurance payers.
Perform accounts receivable follow-up, identifying and resolving denied, underpaid, or unpaid claims.
Allara is a comprehensive women's health provider that offers expert, longitudinal care for hormonal, metabolic, and reproductive conditions. It is one of the fastest-growing women's health platforms in the U.S., trusted by thousands of women nationwide.
Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.
Clover Health provides healthcare plans for seniors, using data and technology to improve care and lower costs. The company is a remote-first, mission-driven organization focused on diversity and inclusion.
Process patient payments and manage payment plans with accuracy and compliance.
Educate patients on billing, insurance verification, and claims-related inquiries.
Resolve billing issues by researching account history and coordinating with internal teams.
Five Star Solutions is a customer service and healthcare billing solutions provider, supporting patient payment and insurance processes. The company fosters a remote work culture with a focus on empathy, accuracy, and compliance.
Analyze, research, and resolve issues related to the creation and submission of paper and electronic claims.
Monitor claim errors, identify opportunities for new edits, and collaborate with the Business Systems Department to implement clearinghouse edits.
Validate daily imports, balance hash totals, and report system issues to IS to ensure timely resolution.
Pediatrix Medical Group is one of the nation’s largest providers of prenatal, neonatal and pediatric services, led by physicians. They offer a diverse range of opportunities, competitive salaries, and a commitment to clinical excellence, focusing on a team approach to improve patient lives.
Post payments, adjustments, and denials from ERAs, EOBs, and lockbox files into customer PM systems.
Balance daily batches, reconcile to bank deposits, and resolve missing or mismatched ERAs.
Flag underpayments and denials, resolve unapplied cash, credit balances, refunds, and transfer balances.
Amperos is healthcare's first AI-native denial management and revenue recovery platform, using agentic AI to resolve claims end-to-end. Backed by a $16M Series A, it remains a small, early-stage team tackling a $260B+ problem with a mission-driven culture.
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.
Work with insurance companies on behalf of patients to obtain payments for Banner Imaging teams
Research and hold payers accountable to pay expected rates according to contracts within allowed timeframes
Expand knowledge in appeals, follow up on denials, send medical records, verify eligibility and authorization, and negotiate with insurers
Banner Health is one of the largest nonprofit health care systems in the country, providing hospital services and care across multiple states. The organization is nationally recognized, earned Great Place To Work Certification, and offers diverse career opportunities with a strong focus on workplace excellence.
Manage the full lifecycle of PIP and Medical Payments claims, from coverage verification and investigation to settlement or denial.
Apply medical cost-containment strategies, coordinate experts, and identify subrogation opportunities while meeting compliance standards.
Work remotely within the US, maintaining accurate claim files and communicating professionally with claimants and stakeholders.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The partner company is seeking a remote Associate PIP Claims Rep to handle Personal Injury Protection claims across multiple states in a structured, compliance-focused environment.
Generate, review, and transmit claims for hospital-based services to third-party payors.
Collaborate across Revenue Cycle departments to resolve billing edits and other up-front issues efficiently.
Report to the Manager of Hospital Billing and support daily billing operations.
Piedmont Healthcare is a healthcare organization providing hospital-based services in Georgia. The company operates a corporate revenue cycle team focused on billing and claims management.
Respond to patient inquiries through chat, email, and internal messaging with clarity, warmth, and professionalism.
Break down complex topics (billing, CPT codes, coverage, device returns) into simple, patient-friendly explanations.
Document all interactions clearly and accurately, ensuring consistent follow-up until issues are fully resolved.
Salvo Health takes a new approach to help millions of Americans facing chronic health conditions, centered on chronic gut health and metabolic conditions. Backed by leading health care investors, Salvo's team includes board-certified physicians, dietitians, nurses, and therapists who provide evidence-based, continuous care.
Analyze high-value and complex claims, ensuring alignment with carrier guidelines and regulatory requirements.
Oversee delegated claims operations and third-party administrators, monitoring compliance and quality.
Provide subject matter expertise and process improvements to strengthen claims governance and outcomes.
They are an insurance organization focused on claims governance, compliance, and operational performance. They are a growing company that prioritizes accountability, service quality, and effective risk management.
Convert raw medical claims (837 EDI, UB-04, CMS-1500) into canonical models applying healthcare coding standards.
Perform data quality audits and write SQL/Spark SQL queries to validate pipeline output and detect overpayment patterns.
Act as SME on claims coding, adjudication rules, and payer policy, mentoring analysts and collaborating with cross-functional teams.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients across the US. Deployed by over 85 health plans and representing more than 270 million lives, the company combines an AI-powered platform with industry expertise to maximize financial outcomes and reduce healthcare costs.
You'll be the first intake for payor eligibility inquiries, handle CS tickets and calls, and pull claims data to root-cause issues.
You'll run the ineligible claims review, determine which flags are truly ineligible or product defaults to correct, and communicate outcomes.
You'll fix problems at the source by documenting recurring patterns, building CS-facing materials, and owning eligibility-risk dashboards.
Pivotal Health is a technology platform that helps healthcare providers get paid fairly in a complex reimbursement landscape by simplifying IDR workflows with AI-driven software, data, and service. The team is collaborative and low-ego, building solutions for reimbursement clarity, with a mission to make healthcare reimbursement fairer for providers.
Conduct detailed audits of medical claims, billing records, coding, and clinical documentation.
Partner with healthcare system clients to resolve billing discrepancies and improve reimbursement.
Serve as a subject matter expert on Medicare, Medicaid, and commercial payer billing requirements.
Jaan Health is an AI-based care management company serving healthcare providers with its Phamily platform to deliver proactive care. It is a fast-growing, early-stage company built on five principles: care, curiosity, clarity, co-creation, and craftsmanship.
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.
Resolve unpaid, denied, or short-paid claims using company billing systems.
Review EOBs and payer correspondence; follow up via portal, phone, email, or fax.
Manage complex denials, appeals, and account resolution with clear documentation.
Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products. With 160 years of clinical excellence, it operates the largest O&P patient care clinic network nationwide, helping people achieve new levels of mobility.
Lead and oversee the Zero Balance team to identify and recover underpaid hospital claims deemed 'zero balance'.
Provide daily supervision, coaching, and performance management to team members.
Analyze claim payments, prepare appeals, and communicate with clients and insurance companies.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, using proprietary algorithms and intelligent automation to improve financial sustainability. The company is a multi-year Top Workplaces award recipient and has been on the Inc. 5000 list of fastest-growing private companies for eleven years.