Job Search Results for healthcare payer

Insight Global is hiring for a Remote Care Manager to support our micro clinic operations in Raleigh, NC. You will work in a virtual setting with providers, paramedics, and patients to partner in the... More care continuum process. You will lead the clinical onboarding of new contracts, handle referrals & authorizations, and ensure seamless communication with all stakeholders.Responsibilities will include: ? Develop and monitor care plans in collaboration with multiple providers, adjusting as needed? Follow up on interventions to prevent unnecessary ER visits and hospital admissions? Serve as the primary liaison between patients, families, and healthcare staff to ensure seamless communication? Navigate multiple healthcare platforms including EHRs, payer portals, billing software, and patient messaging systems? Ensure timely and accurate documentation across systems to support care continuity and compliance? Verify provider participation, coverage, and pre-authorization requirements with insurance administrators and healthcare facilities? Optimize client contracts and referral workflows to enhance scalability and efficiency in care coordination? Schedule and manage appointments, follow-ups, and referrals to specialists and services? Educate patients on conditions, medications, and treatment plans to promote understanding and adherence? Track patient progress and address barriers to treatment plan complianceWe 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

This role supports our client?s population health programs by helping the organization succeed in value based care initiatives. Each day, the analyst pulls and analyzes data from systems like Epic,... More Databricks, SQL, Excel, and payer files to understand trends in cost, quality, and patient outcomes. They build Power BI dashboards, prepare reports, and support meetings with clinical, business, and IT teams. The analyst also monitors performance in ACOs and value based contracts, identifies patterns to improve care and reduce costs, and ensures data quality.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

A growing integrated primary care center in Eastern NC is seeking a Certified Medical Assistant to support a high-impact, patient-centered clinic environment. Responsibilities Room and prepare... More patients; collect vitals and medical history Perform phlebotomy, lab coordination, and urine sample collection Administer injections in clinic and at local group homes Travel to partner group homes for sample collection and patient support Manage front office tasks including scheduling, phone triage, and closing procedures Maintain clinic cleanliness, stock supplies, and support daily operations Work independently at times when provider is offsiteWe 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

Insight Global's client is seeking an Insurance Verification Specialist to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This person will be responsible for reviewing... More insurance verification exceptions, resolving missing or incomplete insurance information, and communicating clearly with patients, insurance carriers, clinics, and internal teams to ensure patient appointments are financially and administratively ready.This is a strong fit for someone with healthcare insurance verification experience who is organized, dependable, comfortable problem-solving independently, and able to keep up in a fast-paced medical office environment.Day-to-Day Responsibilities-Review daily insurance verification work queues and exception reports from spreadsheets, dashboards, and vendor-supported workflows.-Use insurance portals, payer websites, and direct carrier outreach to verify patient insurance eligibility, benefits, coverage details, and missing information.-Contact patients by phone, email, or follow up on system-generated messages when updated insurance cards, policy details, or additional information are needed.-Communicate with insurance carriers, workers? compensation contacts, and motor vehicle adjusters to gather accurate coverage information when applicable.-Document verification details clearly in the EMR system so clinics, collectors, surgical coordinators, and other internal teams can reference accurate information.-Identify inactive policies, referral needs, benefit issues, or other insurance-related concerns and proactively communicate them to the appropriate teams.-Support verification needs across the full practice rather than one specific provider, averaging approximately 30 patient verifications per day.-Collaborate with the local Insurance Verification team and help cover shared work when teammates are out or volume shifts.Compensation:$20 to $23 per hour. Benefits: -Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance-401k and Profit sharing-Paid Time Off-Contribution to Health Benefits-Company Discounts on Products & ServicesWe 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

The Director of Compliance & Safety will serve as the organization's subject matter expert for regulatory compliance, accreditation, quality, and laboratory safety. This individual will be... More responsible for developing, implementing, and maintaining comprehensive compliance and safety programs while ensuring adherence to CLIA, CAP, OSHA, HIPAA, CMS, OIG, Tennessee Department of Health, and other applicable regulatory requirements. The role will partner closely with laboratory and executive leadership to promote a culture of compliance, quality, and continuous improvement.Key ResponsibilitiesDevelop, implement, and maintain the laboratory compliance programEnsure ongoing compliance with CLIA, CAP, OSHA, HIPAA, CMS, OIG, state, and federal regulationsLead regulatory risk assessments, investigations, and mitigation effortsMaintain inspection readiness for CLIA, CAP, CMS, payer, and client auditsOversee document control, policy management, and regulatory record retentionDirect laboratory safety programs, including chemical hygiene, exposure control, emergency preparedness, and waste managementConduct safety rounds, incident investigations, and risk assessmentsPartner with Quality leadership to oversee internal audits, CAPA, RCA, occurrence management, and risk programsDevelop and manage compliance and safety training programsCollaborate with Revenue Cycle and Billing teams to ensure coding, documentation, and billing complianceMonitor compliance related to toxicology testing, chain-of-custody processes, and controlled substance requirementsPresent compliance updates and reporting to executive leadership and board stakeholdersLead and mentor compliance, quality, and safety personnelWe 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

A client of Insight Global is seeking a Home Infusion Billing and Reimbursement Manager to lead revenue cycle operations within a home infusion environment. This role is responsible for overseeing... More billing, collections, payment posting, and denial management while ensuring accuracy and compliance across reimbursement processes.The manager will partner cross-functionally with operations, clinical teams, and leadership to improve cash collections, reduce reimbursement leakage, and optimize overall financial performance. Additionally, this individual will monitor key revenue cycle metrics, drive process improvements, manage audits, and lead a team of reimbursement professionals.Key Responsibilities:- Lead billing and reimbursement operations including claims, collections, payment posting, and AR follow-up- Oversee end-to-end revenue cycle processes (intake, authorization, billing, collections)- Manage denials, underpayments, and appeals to maximize reimbursement- Track key metrics (DSO, aging, denial trends, cash collections) and improve performance- Ensure accurate, compliant billing and maintain reimbursement systems/data- Prepare reporting and support month-end revenue cycle activities- Conduct audits and support compliance with payer requirements- Serve as reimbursement SME and partner with leadership on process improvements- Manage and develop billing/reimbursement staffThis role is primarily computer-based and may be performed in an office, hybrid, or remote setting, with schedule flexibility based on operational needs.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

The Lead Informatics & Analytics Developer will serve as the primary hands-on technical lead for healthcare data, reporting, and analytics. This person will be responsible for developing Power BI... More dashboards, working directly with Snowflake data, building scalable data models, writing SQL queries, validating reporting logic, and supporting data governance efforts.The ideal candidate has strong experience working with large healthcare data sets, preferably within an EMR environment such as Athena or Epic. Athena experience is highly preferred, specifically Athena DataView, which is Prism?s Snowflake-based data source. This role is best suited for someone who can do more than create front-end visuals. They need to understand how to apply business logic in the data model, clean and transform data, troubleshoot issues, and create reliable reporting that stakeholders can trust.This is a hands-on developer role, not a purely strategic or administrative position. The person in this role will be expected to work directly in Snowflake, Power BI, SQL, and the underlying data models to support clinical, operational, financial, pharmacy, quality, grants, and executive reporting needs.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

A healthcare payor client is seeking an MDM/RDM Architect to optimize and scale their Master Data Management Solutions that support complex data integration initiatives. As the MDM Architect you will... More serve at the first escalation point for defining how the member, provider and reference data is mastered across the enterprise. This is a high-impact, strategic role helping drive data accuracy, interoperability and better business outcomes. Key Responsibilities include: Architecture & Solution Design (40%) ? Design and enhance MDM/Reference Data architecture supporting enterprise data initiatives? Define and implement: Match & merge logic, Survivorship rules, Golden record frameworks? Establish and maintain data architecture standards and best practices? Translate business requirements into scalable data architecture solutions Data Integration & Engineering Oversight (30%)? Design and guide data movement pipelines across: ? On-prem systems (SQL Server, NoSQL, Oracle, etc.)? Azure cloud environment? Support ETL development, SQL processes, and job automation (Tidal) ? Oversee integration of member and provider data into centralized MDM platform Platform Optimization & Support (20%) ? Ensure stability of production MDM and data integration processes? Serve as the technical escalation point for complex MDM/data issues? Identify and implement enhancements to improve data quality and system efficiency Data Governance & Quality(10%) ? Support creation and maintenance of golden records (member & provider)? Guide data quality, reconciliation, and integrity processesWe 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

Day-to-Day:?Serve as a senior technical lead within the Data Engineering organization?Oversee data intake processes and determine how new data sources are integrated into the enterprise... More environment?Design, build, and maintain Microsoft Fabric Lakehouse solutions?Develop and support PySpark-based data engineering solutions?Lead operational support and ongoing optimization of enterprise data platforms?Build and maintain CI/CD pipelines and deployment processes?Partner with business and technical teams to develop scalable data architectures?Support the full data lifecycle from ingestion through consumption by BI teams and external data consumers?Manage multiple concurrent initiatives while ensuring platform performance and reliability?Provide technical guidance and leadership across the engineering organization?Act as a hands-on contributor while helping drive team success and operational excellenceJob Description:Insight Global is seeking a Lead Data Engineer for a leading healthcare client in the Philadelphia area. This individual will serve as a lead member of the Data Engineering organization responsible for designing, building, and supporting enterprise data platforms within Microsoft Fabric and Azure environments. They will be one of three leads on the team and will balance leadership and hands-on development. The ideal candidate brings experience with PySpark, Fabric Lakehouse development, CI/CD pipeline support, and modern cloud-based data architectures. This role goes beyond traditional development work, it requires someone who can take ownership of data initiatives from intake through delivery, building the underlying infrastructure that enables data to move through its lifecycle and ultimately be consumed by BI teams, external partners, and enterprise stakeholders. The team is seeking a highly proactive, hands-on leader who can independently drive projects forward, support operations, mentor team members, and serve as a trusted technical resource. Candidates must possess strong communication skills, leadership potential, and the ability to step in immediately to support team operations.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

Hybrid/ Full Time (Must be able to go onsite for training the first two weeks)A national healthcare consulting and claims administration organization is adding a Medical Claims Examiner due to... More continued growth and increased client volume. On a daily basis, you will review professional and facility medical claims for accuracy, medical necessity, and policy alignment. You?ll interpret clinical documentation and coding to determine appropriate payment outcomes, identify discrepancies or potential overbilling, and communicate decisions to providers and internal partners.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