Lead payment integrity strategy and execution, including pre- and post-payment reviews, fraud prevention, and recovery efforts.
Build and manage high-performing multi-vendor portfolios, enforcing SLAs and optimizing contingency fee structures.
Partner with cross-functional teams to continuously improve claims payment outcomes and drive plan affordability.
Gravie creates health benefits that actually benefit small and midsize businesses and their employees. They are well-capitalized with a unique, non-hierarchical culture that values diversity and high performance.
Drive top-line revenue growth by advancing payment accuracy sales opportunities with sales and account management teams.
Serve as a technical and domain SME during sales engagements, focusing on claims and payment integrity workflows.
Deliver compelling presentations and demos of Availity payment accuracy solutions to prospective and current customers.
Availity delivers revenue cycle and related business solutions for health care professionals. With over 2 million providers connected and 12 billion transactions annually, they foster an energetic, forward-thinking culture focused on innovation.
Lead clinical quality strategy and client audit readiness for high-stakes client and consultant engagements.
Build longitudinal quality assurance systems to monitor member journeys and ensure service reliability.
Drive AI-enabled quality surveillance and pattern detection to scale quality operations.
Included Health is a healthcare company that delivers integrated virtual care and navigation, breaking down barriers to provide high-quality care for every person. The company is remote-first and offers a comprehensive benefits package, aiming to raise the standard of healthcare for everyone.
Define product requirements, audit methodologies, and business logic for scalable DRG audit workflows.
Partner with data science and AI teams to develop clinical entity extraction and validate model outputs.
Represent the voice of the customer in client discovery sessions and product demonstrations.
Abacus Insights transforms healthcare data for health plans, helping them break down silos to create a trusted data foundation for better decisions. Backed by $100M from top investors, they are a bold, curious, and collaborative team that embraces AI and automation.
Lead and mentor the Service Delivery team in all Tier 1 and 2 consulting initiatives, providing product education and subject matter expertise on healthcare payment methodologies and operations.
Manage escalated client issues by acting as a liaison between clients and internal support teams to ensure accurate problem resolution.
Develop and maintain capabilities and tools, conduct scoping sessions, and collaborate with cross-functional teams to enhance client outcomes.
HealthEdge is a healthcare technology company specializing in payment integrity and claims adjudication software. The company prides itself on a collaborative, user-driven culture with a focus on impact over ego.
Oversee specialized teams supporting revenue integrity ROI activities, ensuring compliance with policies and timely completion.
Act as liaison between MRO and client audit and PFS leaders, managing workflow and client relationships.
Manage labor and expenditures to budget, and conduct performance reviews for direct reports and area managers.
MRO is the industry leader in Release of Information (ROI) and Health Information Management (HIM) services, partnering with hospitals and health systems nationwide. The company emphasizes compliance, operational excellence, and client-focused service.
Lead Omada's Clinical Quality department with end-to-end accountability for program integrity, performance, and continuous improvement across cardiometabolic programs.
Define and drive the near-term roadmap for program quality, accreditation readiness, quality analytics, and AI bias monitoring.
Build durable quality infrastructure that supports a growing portfolio of clinical products and care experiences, partnering across teams.
Omada Health is a virtual-first healthcare company on a mission to bend the curve of chronic disease by combining human-led care teams, connected devices, and AI-enabled technology. The company has served over two million members across 2,000+ employers and health plans, and fosters a culture of trust, context, boldness, and collaboration.
Plan, develop, and direct all aspects of onshore and offshore BPaaS activities to ensure operational efficiency and customer success.
Establish operational objectives, policies, and procedures in compliance with contracts and regulations, and develop strategies to achieve key performance measures.
Provide executive-level briefings to senior leadership and build collaborative relationships with client leadership to drive continuous improvement.
UST HealthProof is on a mission to reshape healthcare insurance by reducing administrative costs and building better healthcare experiences for health plans and their members. The company is run by leaders with strong health plan and technology backgrounds, fostering a supportive, start-up-like environment that nurtures individual growth.
Architect and execute the strategic roadmap for provider data management, credentialing, and network adequacy, acting as the enterprise authority on data integrity.
Lead a high-performing remote team, establishing rigorous metrics for third-party vendors and integrating AI/LLMs to automate and optimize provider data processes.
Oversee the accuracy and compliance of the Provider Directory, partner with the Chief Medical Officer on credentialing, and drive cross-functional collaboration across Clinical, Claims, and Product teams.
Clover Health is redefining health insurance by leveraging data and technology to deliver personalized, high-quality care for Medicare Advantage members, aiming to make healthcare easier and more accessible. As a mission-driven company with a remote-first culture, they prioritize diversity and inclusion, fostering a team of passionate individuals focused on improving lives through innovation.
Define and communicate the product vision, strategy, and roadmap for AI/ML clinical documentation improvement solutions.
Own the product backlog and lead the development process from ideation to launch, grounded in agile best practices.
Work hand-in-hand with data scientists and engineers to ship high-quality, scalable solutions.
Sift Healthcare is a data science company that uses AI to improve healthcare payments operations and outcomes. It is a growing, dynamic team based in Milwaukee, Wisconsin.
Own the Provider Core domain, building systems that power providers and external partners.
Define intelligent referral strategies and establish data exchange foundations for integrated care.
Drive network expansion and cross-functional collaboration with clinical, engineering, and compliance teams.
Headspace provides lifelong mental health support through evidence-based content, clinical care, and innovative technology. The company serves millions of members globally and fosters a collaborative, mission-driven culture centered on values like 'Make the Mission Matter' and 'Connect with Courage.'
Deliver production-grade AI products using LLMs, NLP, and ML to process unstructured clinical data and drive early disease identification.
Collaborate with Market Operations, Insights Engineering, and Clinical teams to create real-world impact.
Communicate the value and opportunities of AI to internal stakeholders in a fast-paced agile environment.
Agilon health is a healthcare company focused on transforming care delivery for seniors through value-based models. With a collaborative culture and a team dedicated to innovation, they aim to improve outcomes for patients and physicians alike.
Develop and implement enterprise-wide revenue cycle strategy, leveraging AI and automation to optimize performance and reduce denials.
Build and lead a high-performing team, fostering accountability and continuous improvement across billing, collections, and patient intake operations.
Partner cross-functionally with Sales, Market Access, and Commercial Operations to ensure seamless revenue cycle integration and maximize reimbursement.
Freenome is a precision diagnostics company that develops AI-enabled automated revenue cycle infrastructure. The company fosters a culture of accountability, continuous improvement, and deep customer focus, and is an equal-opportunity employer.
Lead end-to-end ownership of process and technology improvement initiatives across Claims Adjudication BPaaS customers.
Manage complex program planning, delivery, and executive stakeholder communication across multiple client accounts.
Conduct operational assessments and partner with functional leaders to identify inefficiencies and scalability constraints.
HealthEdge provides software and services for healthcare administration, including BPaaS claims operations. The company operates in a remote-first environment and is an equal opportunity employer committed to workforce diversity.
Lead AI-enabled workflow redesign by partnering with business leaders to identify high-value workflows and translate business problems into AI-enabled solutions.
Operationalize AI cross-functionally by building repeatable patterns and playbooks, driving adoption and behavior change across the organization.
Measure value and scale what works by defining baseline metrics, tracking value realization, and recommending which solutions to scale based on evidence.
HealthEquity aims to save and improve lives by empowering healthcare consumers. They are a mission-driven company with a focus on HSA solutions, committed to diversity and inclusion, and offer a remote-first culture.
Support client onboarding projects, identify scalable improvements through automation and AI, and guide team members on complex tasks.
Independently manage end-to-end client implementation projects with high performance and accountability.
Operate as a subject matter expert on specific onboarding tasks, collaborating with leadership to enhance workflows.
Experian is a global data and technology company that powers opportunities by redefining lending, preventing fraud, and simplifying healthcare. With 23,300 people across 32 countries, we are a FTSE 100 company known for our people-first culture and recognition as a World's Best Workplace™.