Job Search Results for healthcare payer

RCM Denials Specialist (Denial Recovery)

Job SummaryInsight Global is seeking a fully remote Denials Specialist for our client specializing in orthopedic denials recovery. The RCM Denials Specialist is responsible for recovering revenue... More lost to denied and underpaid orthopedic medical claims by executing payer-specific denial recovery workflows with a high level of accuracy and efficiency. This role focuses on post-payment denials and unpaid claims, managing appeals from initial denial through final resolution. The specialist works within standardized playbooks and performance metrics to directly impact client cash flow and recovered revenue.This is a production-driven, outcomes-focused role suited for professionals who thrive in structured, KPI-driven environments and take ownership of financial results.Key Responsibilities: Denial Recovery & Appeals- Work assigned denial and underpayment claim queues, including post-pay denials, medical necessity, bundling, timely filing, and workers? compensation claims- Prepare, submit, and track appeals in accordance with payer- and CPT-specific guidelines- Follow up with insurance payers via phone, online portals, and written correspondence until final resolution- Ensure timely progression of claims and avoid preventable delays in follow-upDocumentation & Accuracy:- Accurately document all claim actions, appeal submissions, and payer communications- Upload, organize, and maintain required clinical and billing documentation- Maintain clean, complete, and audit-ready records suitable for internal leadership and client review- Meet high accuracy standards while maintaining daily and weekly productivity targetsWorkflow Execution & Collaboration- Adhere to standardized recovery playbooks and escalation thresholds- Escalate complex or unusual denial patterns appropriately- Collaborate with leadership, QA, and strategy teams to improve recovery outcomes- Identify and report payer trends, denial patterns, and workflow improvement opportunitiesWe 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

Revenue Cycle Project Manager

Insight Global is looking for a Project Manager for one of their healthcare clients in New Jersey. This Financial Project Manager will be responsible for assessing and stabilizing a significant... More collections backlog resulting from EPIC implementation challenges by analyzing aged A/R, stalled and denied claims, and clearinghouse rejections to identify root causes and recovery opportunities. Working closely with billing specialists, IT, Epic analysts, and external vendors, the PM will troubleshoot claim edits, payer rejections, eligibility and authorization issues, and interface errors, while prioritizing high-value accounts for resolution. The role involves overseeing daily collections activity, monitoring account balances and key revenue cycle metrics, and driving short-term backlog reduction plans while simultaneously implementing standardized workflows and process improvements to prevent recurrence. Reporting directly to the CFO, this individual will provide clear executive-level updates on cash recovery, risks, and performance trends, ensure compliance with payer contracts and healthcare regulations, and serve as the central point of coordination to restore revenue cycle efficiency and maximize reimbursement 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

Epic HB Contract Reimbursement Analyst

Insight Global is seeking an IT Application Analyst Level III ? Epic Resolute Contract Management professional for a top healthcare client. This individual will play a critical role in building,... More maintaining, and optimizing complex payer contracts across multiple Epic Resolute applications. The ideal candidate is a seasoned Epic analyst with strong revenue cycle expertise who enjoys partnering with business and operational leaders to ensure accurate reimbursement, regulatory compliance, and system excellence. This role offers high visibility, meaningful impact, and a flexible remote or hybrid work environment.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

Provider Relations Specialist

A national healthcare organization is seeking a Provider Relations / Network Development Specialist to support the expansion and maintenance of its provider network across Southeast and Midwest... More markets. This role is centered on provider outreach, relationship management, contract negotiations, and onboarding, ensuring network adequacy and access standards rather than talent acquisition or employment recruiting.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 AI Product Manager

Insight Global is seeking to Lead AI Product Managers to join a global healthcare insurance provider client. One of the Product Managers will be providing support to a rapidly growing platform that... More enables members to understand and act on their healthcare benefits, claims, medications, and recommendations. The other role will focus on driving vision and evolution of products, with a focus on enhancing the right-hand search experience through relevant recommendations, third-party integrations, and deterministic AI-powered capabilities.The ideal candidate profile for both of these roles is someone who has demonstrated knowledge of technical AI and agentic concepts and has strong communication skills and experience working with technical stakeholders. These 2 opportunities are great for candidates looking to making an impact on the future of healthcare through the use of AI. . Compensation: $70 - 90/hr. Exact compensation may vary based on several factors, including skills, experience, and 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

Pre-Authorization Coordinator

Job DescriptionThe PAVE Coordinator is responsible for initiating Pre-Authorization request to the payer for the claims that require approval. This position require communication with payers,... More patients, physician offices and hospital clinical staff. This position is primarily responsible for pre-certifying procedures ordered by physicians. The PAVE Coordinator will also be responsible monitoring appropriateness and medical necessity and provides necessary information for authorization and continued visits. This individual will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed in addition to conducting quality assurance.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information. Advises patients of their financial obligation and collects payments in a courteous and professional manner.Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information;Updates systems with accurate information obtained; performs quality assurance audits and reports back to leadership opportunities for providing education to patient accessResponsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel;Ensures that proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services and held responsible for timely notification to payers of the patient?s visit to the facility to protect financial standing of the organization. Escalates non-authorized accounts/visits to management;Ensures all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, pre-certifications, and financial obligations of patients, are documented on account, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts and denial prevention.;Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling departments. Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned;Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related PAVE account issues, within defined time frames; Adheres to the department accuracy and performance standards.Contact payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization;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

Denial Coordinator

Insight Global is looking for a Denial Coordinator to support a large hospital system in the Maryland/DC area. This person will support the Denials Appeals and Performance team, a centralized... More hospital denial team serving 10 hospitals. This role is hospital-based and denial-type driven, with work assigned via CARC codes rather than by inpatient or outpatient setting. Denials primarily include no-authorization (technical) and medical necessity / level-of-care (clinical) denials. Denial Coordinators work closely with RN reviewers and fellow technical staff in a fast-paced, collaborative environment.This is a production-focused role, with an expected daily volume of approximately 40 appeals per day, varying in complexity. Primary Responsibilities:- Work hospital denial accounts routed through proprietary system based on denial reason- Review denial letters to determine appeal feasibility and next steps- Draft and submit clear, detailed appeal letters for: ? No-authorization denials (technical)? Medical necessity and level-of-care denials (in partnership with RNs)- Collaborate daily with: ? RN reviewers? Other denial coordinators? Leadership and managed care partners as needed- Maintain timely follow-up on appealed accounts to ensure resolution- Identify denial trends and escalate issues appropriately- Participate in: ? Daily huddles? Case review meetings? Interdisciplinary denial discussions- Support special projects related to denial trends, payer behavior, or backlog reduction- Adapt to evolving workflows as the DAP team continues to build and scaleWe 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

Contract Management Associate

Insight Global is looking for a Contract Management Associate to support a healthcare contract management team within a large hospital system serving the Maryland and Washington DC region. This role... More is responsible for supporting post-payment contract management activities by analyzing payer reimbursement data, identifying payment variances, and validating contract accuracy. The associate will work closely with the Contract Management lead and follow-up teams to ensure claims are reimbursed according to contract terms. This role is highly analytical and operational, focusing on daily reporting, balancing and reconciliation, and first-level contract validations. The associate will regularly pull reports from contract management systems (such as FinThrive), review payment results, identify discrepancies related to underpayments or non-payments, and route findings to the appropriate follow-up teams. This position is not data entry?focused and requires someone who can identify trends, think critically about data, and manage time-based daily deliverables in a high-volume contract environment.Primary Responsibilities:Contract & Payment AnalysisAnalyze contract payment data to identify underpayments, non-payments, and reimbursement variancesReview payer payments against contract terms to confirm accurate reimbursementIdentify trends or recurring issues within contracts and escalate findings to the Contract Management leadReporting & Daily OperationsRun daily and ad-hoc reports from contract management systems (e.g., FinThrive)Perform balance reconciliation to ensure data accuracy and completenessDistribute reports to internal follow-up or revenue cycle teams based on findingsManage time-based daily tasks (balancing, report execution, data validation)Contract ValidationSupport first-level contract validations for new or existing contractsReview contract details and ensure system builds align with agreed-upon termsPull and review test claims to confirm correct pricing and reimbursementEnsure all validation steps are completed thoroughly and documentedCollaboration & SupportPartner closely with the Contract Management lead and follow-up teamsRoute identified variances to the appropriate internal teams for resolutionSupport a high-volume portfolio of contracts in a fast-paced environmentLearn and adapt quickly as the team prepares for an eventual Epic transitionWe 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 Sr. Data Analyst

Working closely with clinical and analytical colleagues, this individual will analyze complex healthcare claims, develop quality and outcomes measures, and translate clinical insight into rigorous,... More actionable data products. This role sits at the intersection of data science, clinical expertise, and meaningful health system impact.Key Responsibilities: -Integrate data from VRDC Medicare/Medicaid claims, commercial claims, EHRs, and public health sources to develop, validate, and implement quality healthcare metrics.-Identify practice patterns that constitute excessive, inappropriate, or low-value services and quantify their prevalence and impact across provider populations.-Partner with clinical stakeholders to 1. understand measure intent and ensure analytical outputs align with real-world care delivery context and 2. refine quality measure definitions and translate requirements into scalable, production-ready code.-Develop and deploy statistical models to support quality measure development, trend analysis, and identification of provider practice patterns.?Manage, prepare, cleanse, and validate data from multiple sources; document data pipelines and analytical methodologies.?Support data acquisition and business development activities involving new data sources and external partnerships.-Develop and deliver executive-level presentations that translate complex analytical results into actionable insights for clinical, operational, and leadership 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

Senior Medical Economic Analyst

This role is responsible for analyzing and evaluating financial and economic data related to healthcare costs, managed care payer rates, and reimbursement. It focuses on identifying financial trends,... More applying reimbursement methodologies, leveraging data tools, and developing financial models to manage revenue effectively. The position involves conducting complex analyses of managed care contracts and proposals, reviewing fee schedules for compliance, and transforming raw data into actionable insights to support executive decision-making. Additionally, the role ensures collaboration with managed care teams across multi-state divisions and represents the organization in discussions with payers across various markets.Job Description:Researches and analyzes managed care data from various financial systems and interface tools.Performs complex and varied healthcare data analysis, including financial modeling and risk forecasting.Identifies and implements improvements in quality control and timeliness of reporting.Extracts, collects, analyzes, and interprets health utilization and financial data.Interprets and analyzes data from various sources using knowledge of healthcare managed care contracts and administrative claims data.Key Responsibilities:Build and analyze reimbursement rate structures for upcoming years.Pull 1?2 years of historical data and use Excel to model trends and methodologies, including stop-loss and per diem models.Forecast future reimbursement rates and financial impacts based on historical data, market trends, and modeling assumptions.Financial Analysis: Evaluate monetary impacts and account-level details to support decision-making.Contract review and interpret payor contract language and translate reimbursement terms into formulas for financial modeling.Stay informed on market insights of active contracts and payor trends to guide negotiations and rate-setting strategies.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