Job Search Results for healthcare payer

Senior Healthcare Data Integration Engineer

We are seeking a Senior Healthcare Data Integration Engineer to work on the Exchange Encounter & Risk Adjustment team. This person will support healthcare payer operations focused on ACA Exchange... More Risk Adjustment, CMS EDGE submissions, encounter data quality, and healthcare data integration. This is a hands-on technical leadership role responsible for troubleshooting complex healthcare data issues, improving encounter data quality, supporting CMS EDGE processes, and partnering across business, IT, data, and vendor teams. This is not a project management role.?Lead technical troubleshooting of encounter and risk adjustment data issues?Analyze CMS EDGE submission errors and drive resolution?Support encounter reconciliation, validation, and error remediation activities?Partner with business, operations, data, IT, and vendor teams?Improve encounter acceptance rates and overall data quality?Translate CMS and business requirements into technical solutions?Provide technical guidance to developers and analystsWe 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 EPIC SENIOR PAYER STRATEGY ANALYST

?Modeling reimbursement rates, analyzing payer performance, and delivering financial insights that directly influence contract negotiations and revenue optimization across the health system.?This... More position requires advanced analytical skills, deep knowledge of healthcare reimbursement methodologies, and proficiency in multiple financial and clinical systems.?The analyst serves as a key advisor to leadership, providing data-driven recommendations that shape payer strategy and financial planning.?Quantify payer issues and policies, monitor payer behavior, and provide analytic support during payer negotiations.?The Senior Payer Strategy Analyst will conduct ad hoc analysis and modelling, including: proposals and counter-proposals during payor negotiations, modeling new payer rates, validating incoming rate changes from payersWe 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

Healthcare Data Analyst

The Healthcare Data Analyst will support business leaders within the HEDIS division with creating reports in PowerBI or Tableau. Additionally, they will validate data and ensure reporting accuracy of... More existing reports and support ongoing data platform and reporting transition activities.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

Denials Specialist (Appeals & Revenue Cycle)

Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This is a part-time opportunity working approximately 10?20 hours/week where candidates will leverage... More their denials and appeals expertise to evaluate and improve AI-driven denial resolution strategies. This role is highly analytical and requires a strong understanding of payer requirements, denial root causes, and effective appeal strategies across multiple payer types. Laptop and equipment will be provided.Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Duration: 3-month contract (potential to extend)Responsibilities:? Review denied claims and evaluate AI-generated denial analysis and appeal recommendations? Assess the quality, logic, and persuasiveness of AI-generated appeal strategies across various denial types (medical necessity, authorization, coding, technical, etc.)? Identify discrepancies where AI recommendations diverge from effective real-world denial management practices? Analyze and explain successful appeal strategies, including payer-specific nuances and documentation requirements? Evaluate appealability and determine optimal approach based on denial type, payer guidelines, and supporting documentation? Provide detailed reasoning behind appeal strategies to help improve AI decision-making models? Identify patterns and trends across denials to highlight systemic issues impacting reimbursement? Partner with product and GTM teams to critique presentations and provide subject matter expertise on denial workflows and payer behaviorWe 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

Claims/EDI Representative

We are seeking a Revenue Cycle Claims & EDI Specialist to support claim submission and error resolution efforts in a fast-paced healthcare environment. This individual will work Epic work queues,... More investigate and correct registration, follow-up, and EDI-related claim errors to ensure timely claim processing and reimbursement. The ideal candidate has a strong understanding of insurance verification and payer requirements across a variety of specialties and insurance types. This is a fully remote position requiring excellent time management skills and the ability to adapt to changing daily workloads.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 Prior Authorization Specialist

Insight Global is seeking a fully remote Prior Authorization Specialist to support a Healthcare AI client. This is a fully remote, part-time opportunity working 10-20 hours/week where candidates will... More leverage their prior authorization expertise to evaluate and improve AI-driven authorization strategies. This role is highly analytical and requires a strong understanding of payer policies, documentation strategies, and real-world authorization workflows. Laptop and equipment will be provided.Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Duration: 3-month contract (potential to extend)Responsibilities:? Review pending authorization requests and evaluate AI-generated prior authorization recommendations and strategies? Assess the quality, logic, and effectiveness of AI recommendations across multiple payers and clinical policies? Identify gaps where AI recommendations differ from real-world prior authorization best practices and explain discrepancies? Provide detailed insights into payer-specific nuances, including portal workflows, policy requirements, and documentation phrasing strategies? Share operational knowledge with product teams to enhance AI-powered authorization processes? Partner with GTM teams to critique presentations and provide subject matter expertise on prior authorization workflowsWe 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

Benefit Investigation Analyst

Day-to-Day: ? Conduct patient benefits investigations and eligibility verifications with national insurance payers and TPAs? Verify coverage, deductibles, co-insurance, and patient financial... More responsibility? Serve as the primary liaison between insurance payers and the sales organization? Accurately document benefit findings and communicate details to sales representatives? Support the patient onboarding process through timely and accurate insurance verification? Respond to benefit-related questions and escalations from sales and internal stakeholders? Maintain patient records and documentation within Salesforce and internal systems? Stay current on payer policies, coverage guidelines, and reimbursement requirements? Ensure compliance with HIPAA and healthcare regulatory standards? Partner with internal operations and authorization teams to support patient access to therapyJob Description:Insight Global is seeking a Benefit Investigation Analyst for a leading medical device client. This individual will act as the bridge between national insurance payers and the sales organization, conducting detailed patient benefits investigations and eligibility verifications. The ideal candidate will have experience navigating healthcare benefits, working with TPAs and national payers, and effectively communicating coverage details to internal stakeholders. This person will play a critical role in helping patients gain access to innovative medical technology by providing accurate benefit information that enables the sales team to educate patients on coverage and financial responsibility. This is a fully remote opportunity with strong long-term growth potential.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

Registration & Charge Error Representative

We are seeking a Patient Registration Specialist to support pre-appointment registration and insurance verification activities for a large healthcare organization. This individual will review and... More resolve registration errors, validate demographic and insurance information, and ensure patient accounts are accurate prior to scheduled appointments. The role requires working efficiently within Epic and other payer portals to prevent downstream billing and authorization issues. The ideal candidate is detail-oriented, knowledgeable in healthcare insurance, and able to manage a high-volume work queue in a fast-paced 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

Claims Dispute Specialist (NSA)

Insight Global's healthcare client is seeking a Claims Dispute Specialist (NSA) to join their growing Revenue Cycle Management team. This individual will play a critical role in managing complex... More medical claim disputes and arbitration processes related to the No Surprises Act (NSA) and state surprise billing regulations. The ideal candidate will bring a strong healthcare claims background, exceptional written communication skills, and the ability to manage multiple deadlines in a fast-paced, highly collaborative environment. This position offers the opportunity to contribute to a growing initiative focused on maximizing reimbursement outcomes, improving dispute processes, and reducing claim backlog.Key Responsibilities:Manage medical claim disputes and appeals related to the No Surprises Act (NSA) and applicable state surprise billing laws.Review EOBs, claim history, reimbursement data, and supporting documentation to determine dispute eligibility and strategy.Prepare detailed written arguments, notices of offer, and supporting documentation for Independent Dispute Resolution (IDR) submissions.Track and manage multiple claim deadlines to ensure all submissions, responses, and arbitration requirements are completed on time.Investigate claim payments, denials, underpayments, and reimbursement discrepancies through analysis of payer communications, contracts, and clinical documentation.Analyze trends and identify opportunities to improve dispute outcomes, workflows, and reimbursement strategies.Collaborate with revenue cycle, finance, payment management, and practice operations teams to resolve issues and communicate dispute status updates.Maintain accurate records and trackers throughout the dispute lifecycle while ensuring compliance with federal and state requirements.Support a growing claims dispute program by contributing process improvements and best practices. Compensation:$55,000 to $70,000 per year annual salary. 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

Medical Coding Specialist (Outpatient / Profee)

Insight Global is seeking a fully remote Medical Coding Specialist (Outpatient / Profee) to support a Healthcare AI client. This is a part-time, fully remote opportunity where candidates will... More leverage their outpatient coding expertise to evaluate and improve AI-driven coding recommendations. This role is highly analytical and requires a strong understanding of outpatient coding guidelines, reimbursement logic, and payer rules across specialties. Laptop and equipment will be provided.Shift Times: Flexible scheduling to work within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Responsibilities:? Review outpatient encounters and evaluate AI-generated coding recommendations across settings such as same-day surgery, observation, ED, clinic, and ancillary services? Assess the accuracy and reasoning behind assigned CPT/HCPCS codes, modifiers, APC groupings, and LCD/NCD compliance? Identify discrepancies where AI-selected codes, modifiers, or APC assignments differ from correct coding practices and explain the rationale? Provide insight into coding decision-making, including modifier sequencing, bundling rules, and payer-specific nuances? Share outpatient coding expertise with internal product teams to improve AI logic and recommendations? Partner with GTM teams to critique coding-related presentations and provide subject matter expertiseWe 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