Interpret medical rules, regulations, fee schedules, and edits that payers post.
Understand and manipulate payer data to build federal, state, and commercial coding and financial tables.
Maximize the efficiency and use of product solutions by properly maintaining payer specific edits.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets and have an amazing team of 25,200 people in 32 countries.
Lead resolution of complex technical issues and system errors requiring cross-team collaboration.
Drive continuous improvement initiatives to enhance EHR system functionality, usability and interoperability.
Provide leadership and mentorship to junior analysts, fostering a culture of collaboration and innovation.
OU Health is Oklahoma's only comprehensive academic health system, comprising hospitals, clinics and centers of excellence. With 11,000 employees and over 1,300 physicians, it is the state's largest doctor network and includes the only freestanding children's hospital and a National Cancer Institute-Designated cancer center.
Monitor and interpret CMS guidance for Medicare, Medicaid, and other healthcare programs.
Partner with internal teams to ensure compliance with regulations and contract obligations.
Maintain regulatory tracking documentation and support development of training materials.
HealthEdge provides healthcare software and services to payers and providers. It is a growing company with a focus on compliance and innovation, fostering a collaborative and remote-friendly culture.
Facilitate client calls related to contracting and payer enrollments.
Run and analyze client KPIs, providing regular reports.
Manage the full contracting and payer enrollment process.
Experity transforms on-demand healthcare across the U.S. by empowering urgent care clinics with industry-leading software. The company fosters a team-first culture with opportunities for flexible work and career development.
Conduct research and structured reviews of documentation to evaluate program performance.
Support day-to-day program execution and maintain project artifacts and workplans.
Present findings and proposed solutions in client-facing meetings and working sessions.
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations, and enhanced service delivery. Founded in 2012, they have over 300 employees nationwide and focus on human-centered services to optimize mission delivery.
Attend new client implementation meetings to discuss eligibility requirements and protocols.
Serve as a point of coordination for member eligibility issue identification and resolution with internal teams and external partners.
Proactively monitor system status and eligibility data to identify potential abnormalities impacting quality and accuracy.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including pharmacy benefit management and health benefit management. They are rebuilding trust in healthcare in the U.S. and value a diverse workplace, providing equal employment opportunities to all employees.
Lead collaboration with business stakeholders to gather and document complex system requirements.
Perform advanced analysis of system functionality and end-to-end business processes.
Serve as senior point of contact for investigating escalated system issues and providing solutions.
Ventra is a leading business solutions provider for facility-based physicians, focusing on Revenue Cycle Management. The company partners with private practices and hospitals, fostering a collaborative culture.
Gather and document business and platform requirements from stakeholders, translating them into functional specifications for development and support.
Act as a bridge between business, product, and engineering teams to ensure alignment and clear communication.
Support workflow orchestration, low-code platform configurations, and contribute to Knowledge Asset delivery including runbooks and UAT test cases.
Miratech is a global IT services and consulting company that helps visionaries change the world by supporting digital transformation for large enterprises. Retaining nearly 1000 full-time professionals and operating in over 25 countries, Miratech has a culture of Relentless Performance with a 99% project success rate.
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.
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.
Set up and validate projects across multiple systems with accuracy and completeness.
Maintain project details, statuses, and billing oversight while managing stakeholder follow-ups.
Support communication via call queue and email, and assist with special ad hoc initiatives.
J.S. Held is a global consulting firm combining technical, scientific, financial, and strategic expertise to advise clients on value realization and risk mitigation. The firm provides comprehensive services to help clients navigate complex, contentious situations, and its team operates in a high-energy, collaborative environment.
Deliver end-to-end implementation and upgrade projects, ensuring alignment with customer requirements.
Provide onsite and remote consulting services, including system installation and configuration.
Conduct client training sessions to support effective adoption of solutions and best practices.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly, objectively, and fairly. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
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.
Deliver high-quality technical support and manage ticketing systems for B2B SaaS customers.
Implement AI-driven support tools and analyze data to improve efficiency and customer experience.
Resolve Tier 1 and Tier 2 tickets, track lifecycle, and ensure SLAs are met through cross-functional communication.
Humata Health creates frictionless prior authorization for providers and payers using AI and automation. It is a physician-led company backed by strategic healthcare investors, operating in a high-growth environment with a focus on innovation.
Serve as the primary technical point of contact for enterprise clients, providing prompt solutions and ensuring issues are resolved or escalated.
Educate clients and internal users on effective tool use, best practices, and new functionality to maximize adoption.
Propose and implement innovative workarounds or optimizations to client roadblocks using existing tools and configurations.
Aledade is a public benefit corporation that empowers independent primary care. Founded in 2014, it is now the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.
Manage inventory support activities across multiple projects, ensuring accurate tracking and reporting.
Monitor inventory levels, equipment availability, and fulfillment status to ensure operational readiness.
Identify and resolve inventory discrepancies, shortages, and data quality issues across systems.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The company fosters a collaborative, supportive, and inclusive remote-first culture with a strong focus on professional growth and continuous learning.
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.
Provide analytical, operational, and commercial support to maximize profitability and ensure continuity of product availability.
Support negotiation, administration, and execution of supply agreements while partnering cross-functionally to align purchasing strategies.
Analyze pricing trends, supplier performance, and demand forecasts to identify cost-saving opportunities and drive efficiencies.
Ferrellgas is a leading propane provider serving communities across America. With a nationwide presence and a commitment to charitable partnerships, the company fosters a supportive culture focused on safety, service, and employee growth.
Thorough analysis of complex information and requirements, certifying changes made to our systems.
Developing and maintaining certain system values and settings, providing complex business consulting support to the IT staff and customers.
Influence others in IT and customer areas through teaching/sharing of specialized knowledge and/or leadership roles
They help protect their customers against life’s uncertainties. Regardless of where you work within the company, you’ll be helping provide protection and peace of mind when their customers need it most.
Collaborate with business stakeholders to gather and document requirements for Workday HCM system enhancements.
Configure, test, and deploy changes within the Workday system, providing ongoing support and troubleshooting.
Develop reports and dashboards to track key HR metrics and participate in cross-functional projects.
MITER Brands is a residential window and door manufacturer, offering a portfolio of brands for new construction and replacement segments. As one of the nation’s largest suppliers with plants across the country, the company fosters a collaborative culture that values inclusion and professional growth.