Manage primary source verification and credentialing processes for healthcare professionals, including licensure verification and databank queries.
Compile and assemble qualification packages for review by the customer's Security & Credentialing Office.
Supervise support staff and ensure compliance with DHA directives and credentialing procedures.
Planned Systems International (PSI) provides healthcare credentialing and privileging support for mission-critical programs. The company offers a competitive total compensation package including medical, dental, vision, 401(k) matching, and professional development opportunities.
Partner with Clinical, Claims, and SIU teams to review claims for billing and coding issues.
Leverage internal AI tools and predictive models to identify anomalous billing patterns and support prepayment audits.
Collaborate with Data Science and Engineering to validate AI-flagged claims and refine machine learning models.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep members healthier. It is a fast-growing, remote-first startup with a mission-driven, collaborative culture focused on improving healthcare.
Own Medicare billing, provider enrollment, and compliance for the group.
Review and release every claim before it goes to Medicare, checking codes and documentation.
Support physicians and their offices with billing questions, onboarding, and payment reports.
Integrated Complex Care Associates (ICC) is a California physician group that serves patients with complex health needs, led by each patient's own primary physician. The team is building its billing function from the ground up, so this role is the first full-time hire and offers a hands-on, independent culture.
Read and interpret de-identified eye care clinical notes.
Evaluate extracted ICD-10 diagnosis codes for clinical accuracy.
Verify that eye laterality is correctly captured based on the text.
Terac is building the world's largest pool of vetted human experts for AI. It provides a platform for researchers, AI labs, and product teams to recruit, screen, and pay specialized study participants across industries and languages.
Process medical claims and appeals accurately and timely, following health plan policies and procedures.
Maintain detailed notes, research claim issues, and communicate outcomes with claimants and teams.
Support customer success teams, escalate operational issues, and help improve claims processes.
Sana is a health plan solution built for small and midsize businesses, with integrated primary care services to make healthcare easy. Founded in 2017, the company is remote-first with a fully distributed team across the U.S., and values curiosity, ownership, and speed.
Lead quality and health equity strategy for value-based programs across payers and populations.
Oversee quality improvement staff and use data to identify and reduce disparities.
Partner with stakeholders to improve outcomes, lower costs, and advance equitable care.
OHSU is Oregon's only public academic health center, providing patient care, groundbreaking research, and health care education. As Portland's largest employer, it operates a system of hospitals and clinics across Oregon and Southwest Washington and values diversity and inclusion.
Coordinate patient reimbursement cases and navigate public/private insurance systems.
Manage documentation, assess funding eligibility, and coordinate pharmacy arrangements.
Communicate compassionately with patients and healthcare professionals to secure treatment coverage.
A partner company provides pharmaceutical reimbursement support, helping patients access specialized treatments for rare diseases. It fosters a collaborative, patient-centered remote culture with comprehensive wellbeing and professional development opportunities.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Conduct detailed outpatient coding audits for ED, SDS, OBS, and I&I services.
Identify coding discrepancies, root causes, and compliance risks to support appropriate reimbursement.
Provide technical guidance and training to coding staff to improve accuracy and quality.
This healthcare organization specializes in hospital outpatient coding, billing, and compliance services. It emphasizes accuracy, quality, and continuous improvement, with a collaborative culture that supports remote work.
Lead end-to-end clinical trial operations, ensuring compliance with GCP and regulatory standards.
Manage study start-up, regulatory submissions, TMFs, budgets, and cross-functional collaborations.
Drive risk mitigation and continuous improvement across clinical development programs.
This company is a clinical development organization focused on delivering high-quality clinical trials and advancing patient care. Its collaborative team of motivated professionals works remotely across the US with a strong emphasis on innovation and continuous improvement.