Job Search Results for healthcare payer

Insight Global is looking for a Home Health Clinical Manager for a client based in Owings Mills MD. The clinical manager will be providing support for overall planning, direction, coordination,... More management, and supervision of all nursing and professional services in conjunction with the Director of Clinical Services. Assures quality of care by reviewing and assessing each service. She/he also monitors the outcomes of clinical service activity by evaluating the performance of clinical staff, ensuring compliance with all agency policies and procedures and regulatory standards, coordinating agency committees, and monitoring the effective and efficient use of budgeted resources (personnel, supplies, equipment).Responsibilities:-Keeps Clinical Director informed on all events which occur involving patients and ordered health services.-Responsible for clinical oversight of clinical services-Advises the Clinical Director as to the basis of the need for additional health services to be provided.-Provides the Clinical Director with statistical data involving patients and clinical services areas when requested.-Develops, evaluates, reviews, revises, and implements policies and procedures; goals and objectives; and standards of care relevant to clinical services and personnel functions.-Ensures clinical documentation is accurate, complete, timely, and compliant with all federal, state, and accreditation standards. Ensure clinical documentation is free of errors that would prevent billing.-Ensures excellent levels of patient satisfaction through clinician education, review of patient feedback, and corrective actions.-Addresses and supports cultural practices, if such practices do not harm others or interfere with the planned course of medical therapy.-Coordinates all patients? services by reviewing plans of treatment, assuring case conferences are conducted, reviewing clinical and progress notes, periodic patient evaluations and determining frequency and/or staffing patterns.-Oversees Agency coding function to ensure coding is appropriate, timely, and compliant.-Supports the Clinical Director with any prescribed activities, investigation, documentation, education, or training as requested-Aids in the Agency?s goal of retaining quality personnel by appropriately hiring, orienting, training, evaluating and disciplining personnel within established policy.-Ensures personnel are scheduled to ensure proper coverage within authorized staffing levels.-Ensures orientation and ongoing training programs are developed and provided for therapy personnel.-Ensures personnel receive timely, complete, and documented orientation and training.-Conducts performance evaluations in a timely, measurable, and objective manner. Communicate this information to the Clinical Director.-Maintains a working knowledge of current Medicare, Medicaid and third-party payer requirements for home care reimbursement and have a proficient and in-depth knowledge of current OASIS dataset.-Communicates and coordinates with physician?s offices, payers, patients/families, outpatient services and inpatient coordinator, regarding the care and status of the patient.-Keeps up to date on new methods, products, trends, etc., and communicates this information to personnel.-Participates in the agency?s information management and performance improvement programs.-Supports and complies with the agency?s policies.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

Job DescriptionThe Director of Patient Financial Services provides strategic leadership and oversight of healthcare receivables operations, including patient registration, billing, accounts... More receivable, cash management, and financial reporting. This role is responsible for optimizing revenue cycle performance, ensuring regulatory compliance, and driving accurate claim submission and timely reimbursement across the organization.The Director will lead a combined team of approximately 75 staff across multiple locations and will partner closely with operational and executive leadership to improve financial outcomes. This role leverages deep expertise in hospital billing, reimbursement, and financial eligibility to resolve complex issues, analyze performance trends, and implement process improvements aligned with organizational goals.Key ResponsibilitiesProvide strategic and operational leadership for all healthcare receivables functions, including billing, AR, cash management, and reportingDirectly manage and develop management teams overseeing approximately 75 staff across hospital and Cape Regional operationsEnsure compliance with federal, state, payer, and industry regulationsAnalyze and resolve complex claim submission and reimbursement issues across departmentsUtilize Epic to support enterprise billing, AR workflows, and reportingOversee budgeting, forecasting, auditing, AR and reserve analysis, and financial performance reportingMonitor healthcare financial indicators and lead continuous improvement initiativesWe 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 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

We are seeking an experienced Senior Data Engineer with deep expertise in health plan / managed care environments to design, develop, and maintain enterprise-grade data solutions. This role will... More support critical healthcare operations and analytics by working with QNXT replicated databases, Oracle platforms, and complex SQL-based data transformations in a Unix/Linux environment.The ideal candidate has hands-on experience supporting payer systems, understands healthcare data models (claims, eligibility, providers, members), and can work independently in a highly regulated environment.Key ResponsibilitiesDesign, develop, and optimize scalable data pipelines and data models supporting healthcare and managed care use casesWork extensively with Oracle databases, including performance tuning, query optimization, and data integrity managementDevelop and maintain complex SQL, PL/SQL, and T-SQL scripts, procedures, functions, and packagesSupport and manage data extracted from QNXT replicated databases, ensuring accuracy, timeliness, and reliabilityCollaborate with business, analytics, and reporting teams to translate health plan requirements into technical solutionsPerform root-cause analysis and resolve data quality, performance, and integration issuesOperate within Unix/Linux environments, including scripting, scheduling, and job monitoringEnsure compliance with healthcare data governance, security, and regulatory standards (HIPAA, PHI handling)Provide technical guidance and mentorship to junior engineers as neededWe 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 Patient Account Follow Up Representative is responsible for post billing insurance follow up to ensure accurate and timely reimbursement. This role works claims after they have been received by... More the payer and focuses on resolving underpayments, denials, and coordination of benefits issues. Representatives communicate directly with insurance carriers and patients regarding co pays, deductibles, denials, and coverage discrepancies while delivering excellent customer service. The representative verifies insurance eligibility and benefits as needed, navigates Epic to review registration details, claim history, and account activity, and uses FinThrive for claims clearing and follow up workflows. This role requires timely and accurate account resolution, clear documentation, and consistent interaction with payers, patients, and internal teams to meet productivity and quality standards. The team is fast paced, so candidates should be prepared to resolve approximately 49 claims/denials per day. There are three open roles in the below focus areas:?AmeriHealth / IBX (Commercial Payers): Follow up on commercial insurance claims, including AmeriHealth, IBX, Horizon, Aetna, and regional plans.?Medicaid: Follow up on Medicaid claims with an emphasis on eligibility, coverage, and payer specific requirements.?Denials & Underpayments: Research and resolve denied and underpaid claims across multiple payer types, including root cause analysis.Main Job Duties: ?Verify eligibility with insurance companies.?Communicate with patients and insurance companies regarding co-pays, deductibles, denials, and Cost of Benefit (COB) issues.?Resolve accounts timely and effectively.?Provides excellent customer service.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

We are seeking a detail-oriented and execution-focused Product Owner to support the delivery of features and enhancements within the healthcare claims administration platform. This role is... More responsible for?translating business and stakeholder needs into clear, actionable user stories that address both functional requirements and non-functional considerations such as performance and scalability,?and working closely with engineering teams to ensure timely, high-quality delivery. The ideal candidate brings healthcare domain knowledge, understands Agile processes, and is comfortable using AI-enabled tools to support requirements definition and backlog management.Backlog Ownership & Agile Execution?Own and manage the product backlog, ensuring stories are well-defined, prioritized, and aligned with sprint goals?Write epics, user stories, and acceptance criteria that are clear, testable, and customer-centric?Refine non-functional requirements (NFRs) and ensuring acceptance criteria reflects scaling and performance expectationsConduct regular backlog grooming and sprint planning in collaboration with the Scrum team?Participate in daily standups, sprint reviews, and retrospectives as an active team member?Ensure user stories meet the definition of ready and done before development and release?Requirements Gathering & User Story Development?Collaborate with stakeholders, subject matter experts, and internal teams to gather and refine product requirements?Use AI tools (where applicable) to support the creation of epics, themes, and user stories?Conduct gap analysis and validation of requirements to ensure completeness and feasibility?Support refinement of use cases, workflows, and functional documentation?Cross-Functional CollaborationServe as the primary point of contact for development teams during sprint execution?Partner with UX/UI designers to ensure user stories are aligned with design principles and usability goals?Support QA teams by clarifying acceptance criteria and reviewing test cases as needed?Participate in production demos and release reviews as neededCoordinate with other Product Owners to manage interdependencies between features?Customer & Stakeholder Engagement?Participate in stakeholder meetings to capture feature requests, enhancement ideas, and feedback?Communicate updates to internal stakeholders on backlog priorities, delivery timelines, and sprint progress?Track SLO/SLA adherence for features within your scopeHelp ensure features delivered meet customer needs and stakeholder expectations?Healthcare Domain Support?Apply working knowledge of healthcare claims workflows, billing terminology, and reimbursement processes?Support compliance with healthcare regulations (HIPAA, HITECH) in collaboration with internal teams?Assist in translating complex healthcare requirements into understandable product featuresWe 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

Our client is seeking a SQL / Power BI Developer to support enterprise-level claims reconciliation, audit controls, and data visibility across critical healthcare systems. This role focuses on... More ensuring financial accuracy, compliance, and traceability across the end-to-end claims lifecycle.You?ll work within Sentara?s existing Azure/Databricks data environment, partnering with data, claims, and business teams to analyze, reconcile, and visualize data moving across multiple systems.This resource will be responsible for: -Building Power BI dashboards that support audit, balancing, and reconciliation controls-Using SQL to reconcile claim counts and dollar amounts across upstream and downstream systems-Working with data housed in Databricks to support analytics and reconciliation reporting-Tracing claims data end-to-end (inbound EDI ? internal processing systems ? outbound Medicaid submissions and response files)-Validating total paid amounts, volumes, and financial accuracy across the claims pipeline-Investigating discrepancies and data variances with business analysts and claims teams-Supporting existing ETL and data ingestion processes and ensure analytical outputs align with source data-Pay rate between $50-57/hrWe 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 is seeking experienced DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will perform Diagnostic Related Group (DRG) validation and quality... More audits on inpatient charts to ensure accurate coding and compliance with federal regulations. This is a remote opportunity and the salary for this role is 95-115k based on the candidates years of experience. Key Responsibilities:Conduct thorough chart reviews to validate that assigned codes accurately reflect the patient?s clinical picture.Utilize ICD-10-CM and ICD-10-PCS coding systems to ensure proper code sequencing and accuracy.Validate Present on Admission (POA) indicators, Severity of Illness (SOI), Risk of Mortality (ROM), Hierarchical Condition Category (HCC) capture, Case Mix Index (CMI), and other coding factors.Apply current clinical criteria including MCG, InterQual, payer clinical policy bulletins, CMS guidelines, NCDs, and LCDs.Adhere to coding guidelines and Clinical Documentation Improvement (CDI) best practices as endorsed by ACDIS and AHIMA.Compose and send queries when documentation is insufficient or unclear.Identify query opportunities and ensure accurate code assignment and sequencing.Maintain high-quality standards in chart reviews to accurately reflect the patient?s condition.Stay current with medical coding guidelines and industry developments.Assist in developing training materials and provide onboarding support to new hires.Support project data analysis, reporting, and feedback for internal teams and external clients.Maintain professional conduct and ensure the confidentiality of Protected Health Information (PHI).Meet or exceed established production and quality metrics.Attend all required meetings and training sessions.May be asked to audit clients? CDI programs, including query reviews and coding analysis.Responsible for maintaining access credentials for company systems and EMRs.Perform other duties as assigned by management.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 Director of Cash Applications is responsible for overseeing cash posting, refunds, and cash reconciliation operations for a multi-hospital health system. This role requires a strong understanding... More of the full revenue cycle, along with a solid analytical and financial reporting background. The Director must be capable of monitoring employee productivity, maintaining human resources documentation, resolving technical and payer-related issues, and ensuring compliance with organizational policies and procedures.Responsibilities:- Oversee all cash application functions, including but not limited to cash posting, refunds, and reconciliation activities- Manage staff quality, productivity, and output benchmarking; perform regular staff quality assurance audits- Design and develop financial reports using various tools to support tracking, investigation, and analysis, and to inform organizational decision-making- Monitor and evaluate the organization?s revenue cycle performance; appropriately delegate work based on departmental priorities and operational needs- Collaborate with internal and external partners such as IT, financial clearinghouses, Finance, and banking partners to identify process improvement opportunities; address issues and implement effective business strategies to reduce costs, increase revenue, and streamline expenditures, taking appropriate remediation actions as needed- Manage projects and delegate responsibilities accordingly- Onboard new team members, providing hands-on, elbow-to-elbow support during the onboarding processWe 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 Physician Relations Manager to support an acute care hospital in Sebastian, Florida. This individual will be responsible for promoting physicians and clinical... More services to employed, network, and non-employed referring providers within an assigned market. The role focuses on developing, executing, and closing strategic clinical sales campaigns aligned with facility and service line initiatives. This position serves as the primary liaison between the hospital and referring providers, acting as a subject matter expert across service lines. The Physician Relations Manager will build strong provider relationships, communicate competitive differentiators, and address operational or access-related issues impacting referrals. Responsibilities include coordinating physician education, shadowing providers to stay current on clinical offerings, supporting CME events, and presenting at leadership meetings.The role requires strong analytical capabilities to evaluate referral and claims data, identify high-potential physician groups, and develop strategic account management plans. The Physician Relations Manager will conduct effective, consultative sales meetings, perform pre-call planning, anticipate objections, and tailor messaging to provider needs. Collaboration with marketing, community relations, PR, and internal physician leadership is critical to drive awareness and growth. This individual will also be responsible for tracking all activities, opportunities, and outcomes within a Physician Relationship Management system, reporting ROI metrics, and communicating market trends and growth opportunities to leadership. Regular travel within the assigned territory and consistent attendance in alignment with organizational policies are expected.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