Job Search Results for healthcare payer

We are seeking a Senior Data QA Tester to support large-scale data initiatives for a healthcare payor client in the Newtown Square, PA area. This person's core focus is to ensure the accuracy,... More reliability and compliance of data for the client's HEIDS, CMS Interoperability (FHIR), Payer Data critical programs. You will collaborate with data engineers, architects, and business stakeholder on these efforts. You will also help transition the organization's QA capabilities from manual-heavy processes to scalable, automation-driven solutions. Key Responsibilities include: ? Lead end-to-end data QA strategy and execution across ETL/ELT pipelines in a healthcare payer environment? Validate payer datasets and regulatory outputs (claims, membership, CMS/FHIR, HEDIS)? Testing databases, data warehousing solutions and other data models across QA/Test lifecycle of an application? Drive QA automation and CI/CD integration across Databricks, ADF, and Azure DevOps? Ensure data quality, governance, and compliance (HIPAA, CMS, lineage, audit readiness)Partner cross-functionally to resolve data issues, improve processes, and mentor junior QA resourcesWe 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 Healthcare Access plans, organizes and directs all activities associated with the front end of the revenue cycle for hospital-based services for inpatient and outpatient and selected... More ambulatory services in accordance with established policies of Cooper University Health Care. Director is responsible for the organization, control and management of customer service, quality assurance, management reporting, budgetary requirements, compliance, records management, registration, eligibility, point of service collection, payer information, employee system training and EPIC application support.Ensures optimal, timely, complete and accurate patient information. Maximizes revenue opportunities while providing optimal customer service to internal and external customers. Focus on quality, customer service, employee engagement and the use of economies of scale.Essential functions include but not limited to: Personnel management within budgetary requirements; participates in the development, implementation and review of departmental operating policies and procedures; develops and implements a plan for departmental growth. The Director will be responsible for 6 leadership reports and 25 staff.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 nonprofit healthcare organization serving the Dallas Fort Worth community. The organization has approximately 230 employees and partners with local health systems. The mission focuses on community... More based care, compliance, and data driven decision making. The Director of Healthcare Informatics and Analytics leads the organization?s analytics, informatics, and reporting function. Reports directly to the VP of IT. Leads a two person informatics and analytics team. This role owns the accuracy, credibility, and delivery of healthcare data used by senior leadership. The Director is both a hands on technical contributor and a people leader. The primary focus is rebuilding trust in data and establishing consistent, reliable reporting practices.Key Responsibilities:Data Governance and LeadershipLead the Data Governance Committee and define reporting standards.Establish consistent KPI definitions and validation processes.Create standard operating procedures for analytics and reporting.Rebuild trust with leadership by improving data accuracy and reliability.Mentor and support a small, cross functional team.Analytics and Executive ReportingDevelop and maintain enterprise dashboards using Power BI.Deliver reporting on revenue, payer mix, and operational performance.Answer executive questions related to Medicare, private pay, and claim conversion.Validate all data before release to senior stakeholders.Technical and Data Engineering WorkWork directly in Snowflake to prepare and model data.Write and optimize SQL queries for reporting and analytics.Partner with IT on data pipelines and integrations.Investigate and resolve data discrepancies across systems.Healthcare and Pharmacy InformaticsSupport Athena EMR reporting and data workflows.Partner with pharmacy leadership on PioneerRx reporting.Provide analytics related to prescription distribution and 340B eligibility.Support required healthcare reporting such as UDS and MIPS.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

Insight Global is seeking an Insurance Follow-Up Specialist to join a revenue cycle team at a large health center in Houston. This individual will be responsible for reviewing, researching, and... More resolving denied or rejected insurance claims, ensuring timely reimbursement and accurate account resolution. The ideal candidate will have a strong background in physician billing, denial management, Medicare, managed care plans, and Epic.This role requires a detail-oriented professional who can effectively analyze complex claims, navigate payer requirements, and work in a fast-paced healthcare 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

This role supports the Managed Care team by analyzing payer contracts, tracking performance metrics, and partnering with revenue cycle teams to improve reimbursement outcomes and ensure compliance... More with payer agreements.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

Position Overview:?This is a newly created leadership role supporting AdventHealth's Managed Care team. The Medical Economics Manager will lead a team of 3 Senior Analysts (with expected growth) and... More focus on maximizing reimbursement from managed care contracts.This is an investigative, audit-style position responsible for identifying reimbursement opportunities, analyzing claims data, interpreting contract language, and determining why payments may not align with contractual expectations.The ideal candidate understands healthcare reimbursement, managed care contracts, commercial insurance, revenue cycle operations, and financial analysis.Day-to-Day ResponsibilitiesReview managed care contracts and reimbursement methodologiesAnalyze claims paid below expected reimbursement levelsInvestigate payment variances and root causesPartner with Revenue Cycle, Billing, Collections, Registration, Negotiation, and Modeling teamsAudit claims and reimbursement practicesReview system data and reporting outputsEnsure compliance with payer requirements and reimbursement standardsLead and develop a team of Senior AnalystsIdentify opportunities to maximize reimbursement revenueWe 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 a detail-oriented Prior Authorization Specialist to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This role is heavily focused on... More true prior authorization work, including initiating authorizations, tracking pending cases, following up with payers, supporting denial workflows, and ensuring documentation is complete and accurate for downstream billing and collections teams.This person will support assigned physicians, manage authorization timelines tied to patient procedures, and work closely with surgical coordinators, providers, insurance carriers, and internal teams to help ensure services are approved prior to being performed. The ideal candidate is organized, proactive, timeline-driven, and comfortable working in a fast-paced healthcare environment where follow-through and attention to detail are critical.Day-to-Day Responsibilities-Initiate, track, and follow up on prior authorizations for scheduled procedures and medical services.-Manage authorization work for assigned physicians, typically supporting approximately four doctors and initiating an average of three new authorizations per day, with the remainder of the workload focused on follow-ups, pending cases, audits, and documentation updates.-Use insurance payer portals such as Availity and Navinet to verify benefits, submit authorization requests, check status updates, and document payer responses.-Review patient insurance coverage and ensure all supporting documentation, medical records, and required forms are complete prior to submission.-Follow up on pending authorizations based on urgency and procedure timing, with consistent updates to spreadsheets, notes, and internal tracking tools.-Communicate authorization status, payer requirements, denials, trends, and urgent issues to surgical coordinators, physicians, and internal staff.-Support denial workflows by notifying surgical coordinators, helping coordinate peer-to-peer reviews, tracking determinations, and assisting with appeal submissions when needed.-Maintain clear, accurate, standardized documentation of all payer communications, provider interactions, follow-ups, and case updates.-Prioritize cases based on patient procedure dates and urgency, including last-minute pending cases that may require strong ownership and follow-through.-Maintain HIPAA compliance and protect patient and company confidentiality at all times.Compensation:$22 to $25 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

Insight Global is seeking a Technical Project Manager to support a large-scale ERP transformation for a leading healthcare payer organization. This TPM will be hybrid onsite 3 days per week in... More Newtown Sq, PA. This individual will play a critical role in leading an 18-month initiative to transition to a new ERP platform, consolidating and rationalizing 16+ third-party systems into a unified full-suite solution. Working closely with a System Integrator and senior leadership, this PM will drive integration efforts, oversee vendor selection, and ensure seamless coordination across technical and business teams. The ideal candidate brings strong ERP implementation experience, deep understanding of integrations, and exceptional communication skills to guide a highly visible, enterprise-wide project.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

Insight Global?s client is seeking a detail-oriented Claims Analyst to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This individual will join a high-volume medical... More billing and revenue cycle team, focusing on insurance claim resolution, denials, AR follow-up, and collections, with a primary focus on out-of-network claims, including those governed by the No Surprises Act (NSA).This person will be responsible for working outstanding insurance claims, troubleshooting denials, reviewing EOBs, following up with payers, and helping resolve aged receivables across out-of-network claims. The ideal candidate has strong medical collections experience, understands how to read and interpret EOBs, and can confidently work claims from identification through resolution, particularly within OON and NSA-related workflows.Day-to-Day Responsibilities-Work a blend of AR follow-up, denials management, and medical collections based on daily claim volume, aging, and dollar amount.-Review, interpret, and troubleshoot EOBs to identify claim issues, underpayments, denials, missing documentation, coding-related concerns, and payer-specific requirements.-Follow up with insurance carriers through payer portals and phone calls to resolve outstanding claims and expedite payment.-Primarily manage out-of-network claims, including claims impacted by No Surprises Act timelines, regulations, and payer requirements.-Prioritize aged receivables and high-dollar accounts while maintaining accurate documentation and claim notes.-Review denials related to medical records requests, EDI rejections, coding issues, and payer processing rules.-Partner with internal team members and trainers to ensure claims are worked accurately and consistently within department standards.-Maintain patient and company confidentiality while ensuring all documentation is clear, accurate, and up to date.Compensation:$25 to $27 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

Insight Global?s client is seeking a detail-oriented Claims Analyst to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This individual will join a high-volume medical... More billing and revenue cycle team, focusing on insurance claim resolution, denials, AR follow-up, and collections across both in-network and out-of-network claims.This person will be responsible for working outstanding insurance claims, troubleshooting denials, reviewing EOBs, following up with payers, and helping resolve aged receivables across both in-network and out-of-network claims. The ideal candidate has strong medical collections experience, understands how to read and interpret EOBs, and can confidently work claims from identification through resolution.Day-to-Day Responsibilities-Work a blend of AR follow-up, denials management, and medical collections based on daily claim volume, aging, and dollar amount.-Review, interpret, and troubleshoot EOBs to identify claim issues, underpayments, denials, missing documentation, coding-related concerns, and payer-specific requirements.-Follow up with insurance carriers through payer portals and phone calls to resolve outstanding claims and expedite payment.-Manage both in-network and out-of-network claims, including claims impacted by No Surprises Act timelines and requirements.-Prioritize aged receivables and high-dollar accounts while maintaining accurate documentation and claim notes.-Review denials related to medical records requests, EDI rejections, coding issues, and payer processing rules.-Partner with internal team members and trainers to ensure claims are worked accurately and consistently within department standards.-Maintain patient and company confidentiality while ensuring all documentation is clear, accurate, and up to date.Compensation:$25 to $27 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