Job Search Results for healthcare payer

Research Billing Specialist

A client of Insight Global is looking for a research billing specialist to support a large healthcare system. This position sits within a specialized Revenue Cycle team focused on clinical research... More billing. The team reviews charges associated with clinical trials to ensure they are billed correctly based on Medicare regulations, clinical trial protocols, and research billing guidelines. After coding is completed, reviewers determine whether charges should be billed to the study, insurance, or both, and investigate claim denials, edits, and reimbursement issues to ensure compliance and accurate revenue capture. This position will be interacting with multiple departments and research teams, so communication skills are very crucial for this role. This is a fully remote position but must live within these specific states AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.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 Director of AI

Our client is seeking a strategic and hands-on leader to oversee the development and deployment of advanced machine learning, predictive analytics, and decision intelligence solutions that directly... More influence customer engagement, care recommendations, operational efficiency, and business outcomes.This team sits at the intersection of data science, analytics, product, and business strategy, transforming complex healthcare and operational data into actionable decisions. The models and systems developed by this group drive critical business functions, including customer targeting, engagement optimization, recommendation engines, outcome forecasting, and performance measurement.The organization is experiencing significant growth, expanding into new markets, customers, and service lines. As a result, the technology, processes, and team supporting these initiatives must scale rapidly while continuing to deliver on near-term business priorities. This role requires a leader who can balance immediate execution with long-term platform development, effectively navigate changing priorities, and build high-performing teams in a fast-paced environment.This is a player-coach leadership position. The ideal candidate is equally comfortable defining organizational strategy, mentoring technical talent, engaging executive stakeholders, and contributing directly to technical architecture and modeling decisions when needed.Primary ResponsibilitiesLead a team of outcome-driven data scientists and ML engineers, with direct accountability for delivery, technical quality, and growth.-Drive cross-functional partnership with Medical Economics, Clinical Operations, Product, and the Data & Intelligence Foundation team.-Own the interface between modeling work and the platform and infrastructure it runs on.-Make build-versus-buy and architecture calls, set the technical bar, and stay hands-on enough to make modeling decisions yourself.-Other duties as assignedSkills -Deep applied ML: supervised learning on tabular and structured data, gradient-boosted trees (XGBoost, LightGBM), feature engineering, calibration, and rigorous offline and online evaluation.-Production ML engineering: model packaging, deployment, monitoring, drift detection, and retraining pipelines. You own model quality in production, not just in a notebook.-Strong software engineering fundamentals: Python, SQL, version control, testing, and code review standards you can set and enforce.-Modern data and ML platform fluency: Databricks, dbt, and AWS (S3, Postgres, DynamoDB). Comfortable making build-versus-buy and architecture calls.-Experimentation and causal rigor: A/B testing, uplift modeling, and the judgment to distinguish correlation from decision-relevant signals.-Sound judgment on where newer methods (LLMs, agents, feature augmentation from external signals) add measured lift versus where they add cost and risk.-You lead with the recommendation and state risks plainly, escalate risk early, and decide fast. Communication is concise and structured.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 in MN

Insight Global is hiring Data Analysts to support a Pharmacy Product Team at a large non-profit payer/provider. Responsibilities include analyzing pharmacy and claims data, developing reporting and... More dashboards, gathering requirements from business partners, performing data validation and quality checks, and delivering actionable insights. The top 5 day-to-day responsibilities are to:? Analyze pharmacy and claims data to identify trends, risks, opportunities, and operational insights.? Partner with business users and product teams to gather requirements, understand user stories, and translate business needs into data solutions.? Create reports, dashboards, and visualizations using tools such as Power BI to support decision-making. ? Use SQL and Python to extract, integrate, validate, and interpret data from multiple systems and sources.? Support data quality, testing, validation, and documentation efforts while working closely with analysts, engineers, product owners, and business stakeholders.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

Epic RTE Analyst

We are looking for a seasoned candidate with Epic RTE experience. You will be coordinating delivery across multiple teams, ongoing optimization, maintenance and performance improvements to the... More system. For new clients, the role helps assign build waves, track tasks, and collaborate with Epic and client stakeholders and will potentially travel to go live sites. Some side projects can include: solutioning and testing integration work, including developing inbound interfaces and supporting future implementations. Additionally, the role partners with teams using the internal platform, helping bridge gaps for teams with limited Epic knowledge.Will travel for go lives- 25% of lessWe 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

VP, Data & Analytics

About the Role:The Vice President of Data & Analytics is the enterprise leader responsible for building and operating the data ecosystem that fuels clinical quality, operational efficiency, financial... More integrity, and value-based care performance across a multi-clinic Medicare organization. This leader owns the enterprise data platform, data architecture, pipelines, governance, analytics, and advanced insights that enable clinicians, operators, and executives to make informed, real-time decisions.The VP partners closely with Clinical Systems, Revenue & Enterprise Systems, Digital, Population Health, Quality, Finance, and Operations to ensure data is accurate, trusted, interoperable, and actionable. This role drives innovation through modern data stack evolution, AI/ML, automation, and reusable data products that support risk adjustment, gaps in care closure, care management, and whole person care. They ensure the organization has the insights needed to improve outcomes, reduce cost, and excel in value-based careKey Responsibilities:Data Platform & Architecture?Own the enterprise data platform (cloud data lake, warehouse, FHIR store, analytics environments).?Define enterprise data architecture, models, and standards across clinical, revenue, and digital domains; guide medallion architecture (Bronze ? Silver ? Gold).?Lead data ingestion from EMR, RCM, ERP (Oracle Fusion), HRIS, digital tools, and partners.?Ensure scalable, high-performance, cost-optimized data environments.Data Strategy, Governance & Quality?Define and execute enterprise data strategy and roadmap across all domains aligned with business and clinical priorities ?Establish data governance, stewardship, and master data management.?Maintain data dictionaries, metadata, lineage, and quality standards.?Monitor and resolve data quality issues impacting billing, reporting, and VBC performance.?Ensure HIPAA, SOC, HITRUST, and regulatory compliance.Analytics, Reporting & Insights?Deliver enterprise reporting for clinical, operational, financial, and regulatory needs.?Maintain dashboards for leadership, clinics, operations, finance, HR, and RCM.?Build predictive models for risk stratification, utilization, and forecasting.?Provide insights that improve provider efficiency, patient outcomes, and operational throughput.Value-Based Care Analytics?Support RAF scoring, HCC analytics, documentation improvement, and quality measure reporting.?Identify gaps in care, rising-risk patients, and high-utilization cohorts.?Analyze payer contracts, shared savings, and VBC performance.Data Products & Self Service?Build reusable data products, curated datasets, and governed metrics.?Enable self-service analytics (Power BI, Looker, Tableau) and drive data literacy.?Promote a culture of data-driven decision-making across the organizationCollaboration Across CTIO & Enterprise?Partner with Clinical Apps, Revenue & Enterprise Apps, Digital, Integrations, and Security.?Support major implementations (EMR, Oracle Fusion, HRIS, RCM) with data migration and reporting.?Ensure data readiness for new clinics, services, and digital initiatives.Innovation & Future State Enablement?Develop AI/ML models and automation triggers.?Adopt emerging technologies (streaming, real-time dashboards, FHIR analytics, GenAI).?Continuously modernize the data platform for scale and performance.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

EPIC REHAB CONSULTANT

Insight Global is seeking an experienced Epic Rehab Consultant to support the largest health system in South Florida's ongoing Epic implementation. This consultant will play a key role in Rehab... More build, implementation, optimization, testing, and go-live activities as Baptist Health prepares for its July 2027 Epic Go-Live. The ideal candidate will bring extensive operational and clinical expertise and serve as a workflow leader for Rehab across the organization.Insight Global is seeking an experienced Epic Rehab Consultant to support the largest health system in South Florida's ongoing Epic implementation. This consultant will play a key role in Rehab build, implementation, optimization, testing, and go-live activities as Baptist Health prepares for its July 2027 Epic Go-Live. The ideal candidate will bring extensive operational and clinical expertise and serve as a workflow leader for Rehab across the organization.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

Payment Application Specialist

The Payment Application Specialist accurately processes payments and maintains reconciliation processes in the CBO. In this role, you will manually and electronically post a high volume of patient... More and insurance payments and adjustments. The Payment Application Specialist is responsible for ensuring all payments received are posted for month end processes.PRIMARY RESPONSIBILITIES INCLUDE BUT NOT LIMITED TO: ?Follows organization policies and procedures?Provides superior customer support to our clients and their customers by responding to questions and requests; effectively escalates issues as required?Cross trained to provide department coverage ?Effectively trains team members?Successfully navigate multiple vendors including but not limited to, payer websites and clearinghouse(s)?Produces and maintains department policies, procedures, documentation, and training materials for role specific activities?Upholds "best practices" in day-to-day processes and workflow standardization to drive maximum efficiencies across the team?Must maintain professional and consistent communication with the team and clients to ensure that all needed items are received in a timely manner?Routinely collaborate with department managers to correct problems and improve services?Informs manager of identified issues or trends?Provides administrative support to business operations by performing processing tasks such as data entry, scanning, mail sorting, or similar activities?Performs timely and accurate importing, applying, processing, and posting ERAs and manual payment posting to practice management system to meet team goals and objectives?Posts live checks, online credit card payments, and EFT deposits?Records batch total with date and initials on payment receipt spreadsheet?Balances batches and runs transaction reports?Verifies all EFT deposits, scanned checks, and zero payments have been posted by month end?Assists with EFT/ERA enrollment for payers ?Reconciles all payments received daily, weekly, and monthly?Manages inbound and outbound calls for multiple clients, this may include handling different topics and being a contact between patients and clients?Meets specified department performance requirements?Resolves support tickets submitted by clients and assigned to department according to metrics assigned?Manages time and multi-tasks appropriately to meet expectations of management and peers?Remote employee is responsible for sufficient internet connectivity and equipment necessary to complete assigned job duties in efficient manner?Remote employee is responsible to keep work area quiet and organized during scheduled working hoursWe 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

Epic Tapestry Analyst

An employer in the Southern California area is seeking two Epic Tapestry Analysts. The first Epic Tapestry Analyst will be responsible for the build aspect of Epic Tapestry, specifically designing... More the system and building components needed to enable incoming capitation functionality within the platform. (Enrollment Filer and Incoming Capitation R&R within the Tapestry module) This is a new build for the organization, and the role involves creating foundational elements to support capitation processes. Day to day duties include the following: lead the design, implementation, and maintenance of EDI workflows within Epic Tapestry, configure and support Enrollment File interfaces and Incoming Capitation R&R processes, troubleshoot and resolve EDI-related issues, including mapping errors, data discrepancies, and transmission failures, and maintain documentation of workflows, configurations, and operational procedures. They will collaborate with internal stakeholders and external payers to ensure timely and accurate data transmission, participate in testing, validation, and go-live support for new and updated interfaces, and will ensure compliance with HIPAA regulations related to health IT and data exchange. The Analyst will work alongside 2 internal resources to help them build and design the capitation functionality. This opportunity is a 6-month contract to hire opportunity. The second Epic Tapestry Analyst will be focusing on advanced build work but requires deeper technical specialization, including LPP extensions, custom cache development, custom rules implementation for configuration, and providing guidance. The key difference is that the second role demands experience implementing functionality in a live organizational environment, whereas the first role may not have that implementation background but brings extensive experience in enrollment filer build. The second Analyst position is a 6 month contract with possible extensions. Both positions will be fully remote, preferably sitting in California, but can also sit in the following states: Arizona, Illinois, Maryland, Michigan, Montana, Nevada, North Carolina, Texas, Utah, Washington & Wisconsin.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

Sr. Director AI & Automation

About the Role:The Sr Director of AI & Automation leads the enterprise strategy, development, and delivery of AI-powered products, GenAI/LLM solutions, intelligent automation, and workflow... More transformation. This role focuses on applied AI, AI productization, LLM innovation, and automation-driven operational efficiency.This leader partners closely with the Data & Analytics organization, which owns data science, ML Ops, model deployment, monitoring, and data engineering. The Sr. Director of AI & Automation focuses on business value, product delivery, workflow transformation, and enterprise adoption.Key Responsibilities:Enterprise AI Strategy (Excluding Data Science & ML Ops)? Define the enterprise AI and GenAI strategy aligned to clinical, RCM, finance, and operational priorities? Identify high-value AI use cases and build a multi-year roadmap? Lead AI product vision, business case development, and value realization? Partner with Data & Analytics for model development, deployment, and ML OpsApplied AI & AI Product Development? Build AI-powered applications using existing models, APIs, and LLMs? Develop prototypes, POCs, and MVPs for AI-enabled workflows? Integrate AI into enterprise systems (EMR, ERP, CRM, RCM platforms)? Own AI product lifecycle: requirements ? design ? validation ? adoption? Ensure AI solutions deliver measurable business outcomesGenAI, LLMs & Emerging Technology? Build LLM-powered copilots, chatbots, summarization tools, and classification engines? Develop prompt engineering standards and evaluation frameworks? Lead RAG-based application development (using Data & Analytics for data pipelines)? Pilot emerging AI technologies (voice AI, agentic workflows, computer vision)? Partner with Engineering to embed LLMs into enterprise workflowsDomain AI Leadership (Without Data Science Ownership)? Clinical AI Enablement: documentation AI, quality measure prediction, workflow augmentation? RCM AI Enablement: denial workflows, coding augmentation, AR segmentation? Digital AI Enablement: chatbots, triage, personalization, provider experience AIResponsible AI & Business Side Governance? Define responsible AI usage guidelines and business guardrails? Ensure explainability, fairness, and ethical use in business workflows? Partner with Compliance, Legal, Security, and Data & Analytics on governance? Oversee business validation, documentation, and audit readinessEnterprise Automation Strategy? Define automation strategy across clinical ops, RCM, finance, HR, supply chain? Manage intake, prioritization, and ROI tracking? Establish automation governance, standards, and best practices? Drive enterprise adoption of automation solutionsRPA & Workflow Automation Delivery? Lead RPA development (UiPath, Automation Anywhere, Power Automate)? Build workflow automations integrated with enterprise systems? Maintain bot library, versioning, and change management? Ensure automation solutions are scalable, resilient, and compliantIntelligent Automation (AI + Automation)? Build document understanding workflows (OCR, NLP, classification)? Automate email/fax routing, triage, and exception handling? Use AI predictions (from Data & Analytics) to trigger automated workflows? Create closed loop intelligent processes (AI ? Automation ? Data ? AI)Process Engineering & Operational Excellence? Lead process mapping, redesign, and optimization? Ensure processes are automation-ready? Deliver measurable improvements in cycle time, throughput, and accuracyWe 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 Observability Engineer

We are seeking a detail-oriented and technically skilled Observability Engineer to join our Reliability Engineering & Operations (REO) team. In this role, you will be responsible for configuring,... More maintaining, and continuously improving the observability stack ? spanning monitoring, dashboarding, alerting, and application performance management (APM) across our AWS-hosted production environments. You will lead the standup of our observability capabilities during an active proof-of-concept (PoC) period, establishing the tooling, instrumentation patterns, and alerting standards that the broader REO organization will rely on. This is a practitioner role for someone who is passionate about making complex systems legible ? turning raw telemetry into actionable insight.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