Support daily provider and coach assignments based on licensure and operational requirements.
Monitor care team panels and ensure compliance with program type and changes.
Provide prompt responses to assignment requests and resolve discrepancies with stakeholders.
Twin Health empowers people to improve and prevent chronic metabolic diseases like type 2 diabetes and obesity using AI Digital Twin technology. With over $100 million raised and a team passionate about metabolic health, Twin Health is recognized as an innovator and a top most loved workplace, scaling rapidly across the U.S. and globally.
Lead strategic initiatives to improve STARS, CAHPS, PWP, and HEDIS performance across the health plan.
Manage a team of 3-6 direct reports and collaborate with cross-functional teams.
Design and evaluate outreach programs to enhance member experience and close care gaps.
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. It is part of Sentara Health, a not-for-profit integrated healthcare provider with nearly 30,000 employees and a family-friendly culture.
Serve as the primary client relationship lead, ensuring alignment on goals, scope, deliverables, and outcomes.
Provide OP HCC CDI subject matter expertise and oversee project execution, quality, and client satisfaction.
Monitor project performance, manage risks and scope changes, and ensure successful delivery of contracted services.
UASI improves the quality and accuracy of clinical documentation through expert CDI consulting. We are a growing team with a collaborative, mission-driven environment that values continuous learning and professional growth.
Act as the clinical and administrative lead for Cooper 365, handling phone matters, patient check-in/out, and appointment scheduling.
Provide medical assistant support including vital screening, EHR maintenance, document scanning, and ensuring patient paperwork is completed.
Manage referrals, recertifications, prior authorizations, and escalate and resolve patient complaints independently.
Cooper University Health Care is a healthcare provider committed to delivering extraordinary care through clinical innovation and advanced technologies. It offers a comprehensive benefits program and opportunities for professional growth, positioning itself as a top employer in South Jersey.
Submit and track provider enrollments with Medicare, Medicaid, and major commercial payers.
Maintain and update credentialing databases and payer status logs.
Collaborate with credentialing team and payer representatives to resolve blockers and shorten approval timelines.
Big Leap is a fast-growing, multi-state medical & behavioral clinician group focused on interventional mental health treatments like Spravato & TMS. The company is expanding its remote operations team to support growth.
Reviews payor denials and audits for potential lost revenue and writes comprehensive appeal arguments using clinical criteria.
Functions as a hospital liaison with external third-party payors and works with Physician advisor team to facilitate appeals.
Monitors and reports payor trends to management, ensuring compliance with regulatory and accrediting requirements.
Jefferson Health is a nationally ranked not-for-profit health care system reimagining health care and higher education to create unparalleled value. With more than 65,000 employees, it serves patients through millions of encounters annually at 32 hospital campuses and over 700 outpatient locations in the greater Philadelphia region, Lehigh Valley, and southern New Jersey.
Responsible for case finding, data abstraction, and follow-up of patients with a cancer diagnosis.
Performs clinical data abstraction to capture complete patient history, diagnosis, staging, and treatment information for the cancer registry.
Utilizes cancer data collection principles and assigns codes based on established systems (STORE, SEER, ICD-O3, AJCC Staging 8th Ed) to ensure compliance.
Winship Cancer Institute of Emory University is Georgia's only National Cancer Institute-designated Comprehensive Cancer Center, dedicated to discovering cures for cancer and inspiring hope. As part of Emory University, a leading research university, they foster excellence and attract world-class talent to innovate today and prepare leaders for the future.
Manage client medical payment policies to ensure accuracy and compliance with CMS and payer guidelines.
Conduct periodic reviews and analyses of policy updates, coordinating with Medical Directors and presenting recommendations to clients.
Serve as the primary client liaison, addressing inquiries and maintaining detailed documentation of policy nuances.
Cotiviti is a healthcare data analytics company specializing in payment accuracy and medical policy management. The company fosters a collaborative remote culture and offers competitive benefits to support its team.
Audit outpatient and specialty claims to ensure coding accuracy, clinical validity, and medical necessity.
Utilize advanced coding knowledge and audit tools to identify billing issues and document findings.
Meet productivity and quality standards while recommending process improvements and new claim types.
Cotiviti is a healthcare analytics and auditing company that focuses on improving claims accuracy and reducing costs for clients. They are a mid-to-large sized employer with a culture that emphasizes quality, collaboration, and innovation in healthcare auditing.