Job Search Results for clinical

PB System integration Analyst II

Job Description:Responsible for the preparation and review of analysis for various PB Coding leadership and external customers by creating a reporting dashboard (PB Coding and Charge Capture... More Dashboard). Work as an operational and technical analyst supporting the technology used by the PB Coding Department in the revenue cycle function. Partner with Revenue cycle, clinical leadership, and IT to identify and analyze root cause of user and system issuesSubmit and track system requests, submit system enhancements and new edits, and participate in system upgradesDevelop efficient workflows and claim scrubber edits Routine Epic maintenance for PB coding, including tasks like managing reports, work queues, revenue setup, and verifying IT configurationsManaging 2 shared inbox requestsDay to day: Request optimizations, innovation, create automation solutions to make the coders and medical reviewers life more efficientKey Responsibilities Include:Sitting in on meetings in new growth projects and ability to drive conversations and have a seat at the table with ITWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE Epic Bridges Analyst

Insight Global is seeking multiple Epic Bridges Consultants for the largest health system in South Florida. The ideal candidate has 5+ years of experience with Epic Bridges and is Epic Bridges... More certified. This candidate will be creating and executing solutions for integrating financial and clinical data across multiple systems. This candidate must have the ability to understand data structures and technical specifications detailing data elements and HL7 message structures. They will provide proactive support by monitoring live connections and be responsible for creating/maintaining overall interface environment documentation. They must be able to prioritize tasks based on severity of user impact, resolve major incidents within the established time limits. They must be able to demonstrate thorough knowledge of computer systems, software, decision support systems, monitoring, report writing tools and electronic communication. This is a fully remote job with 1 week of travel required, occurring the first week of every month.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Level 2 - REMOTE BCBS Facility Claim Follow-Up Representative

Insight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing,... More specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues?not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).Primary Responsibilities:Claims Management:?Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid.?Determine what was paid, what was denied, and why.?Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc. Payer Interaction:?Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard. ?Understand and navigate multiple contracts. ?Utilize BCBS portal to follow up and resolve outstanding claim issues.Analytical Review:?Differentiate between pricing errors vs. payment errors.?Accurately price claims based on contract terms and identify variances.Scope of Work:?Outpatient facility claims ONLY ?Technical denials ONLYWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Trainer

We are seeking an experienced Infor CloudSuite Workforce Management (WFM) and Multi-View Scheduling (MVS) Trainer to support a large-scale scheduling system implementation for a major healthcare... More organization. This role is responsible for delivering high-quality training to approximately 800 nurse schedulers as they transition to the new scheduling module. Training materials will be fully developed and provided?your primary responsibility is to lead engaging, effective training sessions and ensure end users feel confident adopting the new technology.This position is remote, with required onsite training days as scheduled.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote UM Physician Reviewer

Insight Global is hiring a fully remote Physician Reviewers for a leading health insurance company. The Physician Reviewer will review requests for care before, during, and after treatment to... More confirm they follow medical guidelines and company policies. This includes checking different types of services like hospital stays, rehab care, medical equipment, and outpatient treatments. They document their decisions clearly so members can easily understand them, and they use the right templates to keep everything consistent. Physician Reviewers also talk directly with doctors when needed to explain decisions or suggest alternative treatments based on medical evidence. They work quickly to meet deadlines, follow all laws and regulations, and handle other related tasks as needed. This is a remote position that requires strong attention to detail, clear communication, and the ability to make informed decisions quickly.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE Pharmacy Data Analyst

Insight Global is hiring a Sr. Data Analyst for a payer/provider. Data analysts are responsible for driving adoption and use of data and analytic services and products. Data analysts work in... More collaborative scrum teams with developers, data scientists, and data engineers, and may share accountabilities in order to achieve sprint goals. They maintain a working knowledge of a business domain and its associated data, and provide visualization, analysis, validation, and consultation services. Together with their teams, they work on building scalable solutions to extract knowledge from data, and deliver that knowledge as needed and at scale.ACCOUNTABILITIES:? All team members must champion and model our values of partnership, curiosity, compassion, integrity, and excellence, and must contribute to a culture of continuous learning? Partners with domain experts, business groups, and data engineers to frame problems, model, clean and integrate data, and determine the best way to leverage that data in service of a goal ? Works with business partners to understand and create their ?user stories;? they support opportunities to leverage data analytics in service of customer or business value ? Creates, deploys, monitors, and maintains highly interactive data visualizations ? Participates in strategic measurement activities, including Return on Investment (ROI) analyses, Key Performance Indicator (KPI) development, risk assessment and indexing, as well as domain-specific measurements (example: readmission rates) ? Works with their teams to ensure data accessibility, accuracy, and quality, and may act as data stewards by contributing to management of central data stores and metadata? May provide consultative, data-driven support on product and business strategy development ? Sets up and executes test cases to validate that analytic and software solutions meet the business acceptance criteria ? Communicates solution tradeoffs to business partners to frame and influence project decisions ? Leverages internal and external sources to validate data accuracy and benchmark results? Promotes and champions our security and de-identification standards, while they handle sensitive administrative data (medical and pharmacy claims, clinical data, and other sensitive organizational data assets).We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Level 1 - REMOTE BCBS Facility Claim Follow-Up Representative

Insight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing,... More specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues?not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).Primary Responsibilities:Claims Management:?Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid.?Determine what was paid, what was denied, and why.?Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc. Payer Interaction:?Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard. ?Understand and navigate multiple contracts. ?Utilize BCBS portal to follow up and resolve outstanding claim issues.Analytical Review:?Differentiate between pricing errors vs. payment errors.?Accurately price claims based on contract terms and identify variances.Scope of Work:?Outpatient facility claims ONLY ?Technical denials ONLYWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote LVN/LPN

A startup healthcare client in the San Francisco area is looking to hire 5 remote LVN or LPNs with California licensure. These individuals will be in charge of meeting with around 15 patients a day... More for 20 minutes to go over the patients care plan and medications, followed by strict documentation for Medicare compliance. He or she will have weekly check ins with the supervising RN. The hours of work will be Monday through Friday 9 to 5 pm.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote CDI Education Specialist

The CDI Education Specialist develops and implements an effective and comprehensive audit & education program for coding consistent with regulatory, contractual, professional standards and healthcare... More revenue cycle industry practices. The education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. They must have excellent communication as they will be articulating guidelines and standards directly with providers of Hartford Healthcare. This candidate must have multi-specialty experience in CDI education.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE Pharmacy Data Product Owner

Insight Global is hiring a Pharmacy Product Owner for a payer/provider. The Product Owner drives the delivery of high-quality analytic products by prioritizing work, shaping user stories, and... More ensuring alignment with business objectives. Acting as the primary liaison to sponsor, the PO ensures clear communication of goals, trade-offs, and progress. They collaborate with developers, analysts, and engineers in Agile teams to build scalable data solutions, maintain domain expertise, and provide consultative support for strategic decisions. Key responsibilities include managing the product roadmap, planning sprints, validating deliverables, and championing data accuracy, security, and compliance?all while driving adoption and measurable business value.ACCOUNTABILITIES:? All team members must champion and model our values of partnership, curiosity, compassion, integrity, and excellence, and must contribute to a culture of continuous learning? Acts as domain experts, partnering with business groups, and data engineers to frame problems, model, clean and integrate data, and determine the best way to leverage that data in service of a goal ? Works with business partners to understand and create their ?user stories;? they identify and clarify opportunities to leverage data analytics in service of customer or business value ? Independently creates, deploys, monitors, and maintains highly interactive data visualizations and analytic services ? Leads and participates in strategic measurement activities, including Return on Investment (ROI) analyses, Key Performance Indicator (KPI) development, risk assessment and indexing, as well as domain-specific measurements (example: readmission rates) ? Works with their teams to ensure data accessibility, accuracy, and quality, and may act as data stewards by contributing to management of central data stores and metadata? Provides consultative, data-driven support on product and business strategy development ? Defines, sets up, and executes test cases to validate that analytic and software solutions meet the business acceptance criteria ? Communicates solution tradeoffs to business partners to frame and influence project decisions? Leverages internal and external sources to validate data accuracy and benchmark resultsPromotes and champions our security and de-identification standards, while they handle sensitive administrative data (medical and pharmacy claims, clinical data, and other sensitive organizational data assets).We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less