Provide clinical and operational leadership to support timely, evidence-based coverage determinations in Utilization Management.
Coach reviewers on consistent application of medical-necessity criteria, medical policy, and benefit plan language.
Monitor daily workflow health, coordinate coverage plans, and communicate barriers and risks to the UM Manager.
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. The company serves employers, health plans, and health systems with data-driven solutions and is on a mission to empower people to lead healthier lives.
Responsible for initiating ERA and EFT setup with clearinghouses and payers.
Assist in vendor support for daily cash reconciliation and understand RCM Payment Posting Processing.
Maintain payer portal admin and employee registration; resolve unidentified payments.
Advantia Health provides unparalleled healthcare services to customers. The company employs highly qualified individuals and is an equal opportunity employer committed to diversity.
Investigate and resolve denied, underpaid, or aging insurance claims using payer portals and billing systems.
Submit timely appeals and manage aging reports to reduce revenue delays.
Collaborate with billing, coding, and operational teams to resolve claim issues and maintain accuracy.
Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. With over 70 clinics across 8 states and a Net Promoter Score of 93, we deliver compassionate, results-driven care in a modern, patient-first environment.
Conduct training and education on risk adjustment documentation and coding guidelines for providers.
Perform comprehensive medical record chart audits to validate ICD-10-CM coding and HCC assignments.
Analyze claims data and audit error rates to identify trends and recapture opportunities for chronic conditions.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, with scalable operations and cloud-based technology.
Lead deep-dive analyses of clinical and technical denials to uncover root causes affecting hospital reimbursement and operational efficiency.
Partner with hospital leadership and revenue cycle teams to present findings and support operational transformation initiatives.
Design and deliver training and documentation to improve denial prevention practices across teams and departments.
Our partner is a healthcare services organization operating in revenue cycle management and analytics. It is a growing company with strong client relationships and a focus on operational transformation.
Provides remote RN approvals and support for field users, responding to requests via phone, fax, and email.
Manages workflow tasks such as data entry, eligibility, scheduling, and POC approvals within 30 minutes.
Monitors communication systems, prioritizes tasks by patient needs, and escalates unresolved issues to management.
Moments Hospice is a leading hospice organization dedicated to personalizing end-of-life care and treating patients, families, and team members like family. The company fosters a supportive community and workplace culture where employees are proud to be part of the Moments family.
Own and shape a regional start-up function, building scalable systems and playbooks for site activation across Central/Eastern Europe and Georgia.
Drive site identification, feasibility, and readiness from CDA through activation, collaborating with sites, CROs, and sponsors.
Monitor cycle times and use data to proactively identify bottlenecks and improve activation timelines.
Iterative Health is a healthcare technology and services company that accelerates clinical research to transform patient outcomes, specializing in gastrointestinal, hepatology, obesity, and cardiology. With 250+ employees worldwide, the company fosters a collaborative, low-ego culture focused on high ownership and accountability.
Provide medical coding, system configuration, and administrative support for medical policy functions.
Perform coding analyses and utilization reporting to recommend updates to medical policies and system configuration.
Participate in cross-functional meetings to align with enterprise strategic priorities and support team operations.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. We prioritize member well-being over profits, with a focus on sustainability and innovation.
Support accurate risk adjustment coding by performing first-pass reviews of member medical records.
Maintain compliance with CMS risk adjustment diagnosis coding guidelines and HCC coding standards.
Collaborate with a remote team and contribute to team success through proactive communication and continuous learning.
BlueCross BlueShield of Tennessee is Tennessee's largest health benefit plan company, helping members since 1945. As a remote-first organization, it fosters a culture of innovation and collaboration with a focus on employee well-being.
Serve as the welcoming anchor for the practice, blending compassionate communication with organizational skills.
Schedule new patient appointments, manage scheduling systems, and collect intake data accurately.
Proactively address cancellations, re-engage patients, and maintain flawless EMR documentation.
Isaac Health improves brain health by providing accessible specialty dementia care services. Founded in 2022, it has scaled across the US with support from leading healthcare investors and a focus on clinical quality.