Job Search Results for healthcare payer

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

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

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

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

Remote FHIR Interoperability Solution Architect

Copilot said: The FHIR Interoperability Solution Architect is responsible for defining, designing, and governing scalable, secure, and standards-based interoperability solutions that enable seamless... More data exchange across the healthcare ecosystem. This role serves as the technical leader for FHIR- and HL7-driven integration strategies, partnering closely with business, engineering, security, and compliance stakeholders to translate functional and non-functional requirements into robust interoperability architectures that meet regulatory, security, performance, and operational objectives. The architect will lead the design and oversight of FHIR-based APIs, healthcare integration platforms, and secure data exchange solutions, ensuring alignment with enterprise architecture standards and industry best practices. A key focus of the role is establishing and governing authorization and trust frameworks, including SMART on FHIR, SMART Backend Services, and UDAP, to support secure payer, provider, member, and partner interoperability use cases. This individual will develop and maintain logical and physical solution architectures aligned with FHIR, HL7, RESTful API standards, and evolving healthcare interoperability requirements, while providing strategic architectural guidance to engineering teams and senior leadership. The role requires staying ahead of emerging interoperability standards, security frameworks, and healthcare regulations, advising the organization on future-state technical strategy, and mentoring architects and engineers on interoperability design patterns, API security, and best practices.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

Billing Specialist

Insight Global is looking for a billing specialist for one of their healthcare clients in New Jersey. Billing specialists will spend their day actively working assigned A/R and suspended claim work... More queues within Epic, focusing on denied, rejected, and stalled claims that are contributing to the collections backlog. They will research claim failures by reviewing payer responses, clearinghouse rejection codes, eligibility and authorization issues, and missing or incorrect clinical or demographic data, then take corrective action such as rebilling claims, submitting appeals, or escalating payer issues as needed. On a daily basis, they will prioritize high-dollar and aged accounts, document all follow-up activity clearly within Epic, and ensure timely resubmission to meet payer filing requirements. Billing specialists will collaborate closely with the Financial Project Manager to flag recurring issues, workflow gaps, or system configuration problems, participate in daily or weekly backlog review huddles, and adjust priorities based on recovery targets. They will also post payments and adjustments accurately, monitor account balances for resolution, and follow standardized procedures designed to improve cash flow, reduce future denials, and support compliance throughout the cleanup effort.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

Epic RTE Analyst

We are looking for a seasoned candidate with Epic RTE experience. You will be coordinating delivery across multiple teams, ongoing optimization, maintenance and performance improvements to the... More system. For new clients, the role helps assign build waves, track tasks, and collaborate with Epic and client stakeholders and will potentially travel to go live sites. Some side projects can include: solutioning and testing integration work, including developing inbound interfaces and supporting future implementations. Additionally, the role partners with teams using the internal platform, helping bridge gaps for teams with limited Epic knowledge.Will travel for go lives- 25% of lessWe 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 Tapestry Analyst

An employer in the Southern California area is seeking two Epic Tapestry Analysts. The first Epic Tapestry Analyst will be responsible for the build aspect of Epic Tapestry, specifically designing... More the system and building components needed to enable incoming capitation functionality within the platform. (Enrollment Filer and Incoming Capitation R&R within the Tapestry module) This is a new build for the organization, and the role involves creating foundational elements to support capitation processes. Day to day duties include the following: lead the design, implementation, and maintenance of EDI workflows within Epic Tapestry, configure and support Enrollment File interfaces and Incoming Capitation R&R processes, troubleshoot and resolve EDI-related issues, including mapping errors, data discrepancies, and transmission failures, and maintain documentation of workflows, configurations, and operational procedures. They will collaborate with internal stakeholders and external payers to ensure timely and accurate data transmission, participate in testing, validation, and go-live support for new and updated interfaces, and will ensure compliance with HIPAA regulations related to health IT and data exchange. The Analyst will work alongside 2 internal resources to help them build and design the capitation functionality. This opportunity is a 6-month contract to hire opportunity. The second Epic Tapestry Analyst will be focusing on advanced build work but requires deeper technical specialization, including LPP extensions, custom cache development, custom rules implementation for configuration, and providing guidance. The key difference is that the second role demands experience implementing functionality in a live organizational environment, whereas the first role may not have that implementation background but brings extensive experience in enrollment filer build. The second Analyst position is a 6 month contract with possible extensions. Both positions will be fully remote, preferably sitting in California, but can also sit in the following states: Arizona, Illinois, Maryland, Michigan, Montana, Nevada, North Carolina, Texas, Utah, Washington & Wisconsin.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

Databricks Data Engineer - INTL India

Insight Global is seeking a highly skilled Senior Data Engineer to support a Teradata Utilization Analysis engagement, which focuses on analyzing Teradata platform utilization to identify... More cost-reduction opportunities and deliver a repeatable, log-driven analysis solution.The ideal candidate combines deep Teradata DBA expertise with hands-on Databricks engineering capability and applied AI/ML skills. The analysis will be performed primarily in Databricks, leveraging DBQL logs, system metadata, and external scheduling/orchestration data sources.Key ResponsibilitiesIngest and validate 18+ months of Teradata DBQL logs including SQL text, object usage, timestamps, user/application IDs, row counts, and steps.Integrate metadata from Autosys (scheduling), DataStage (orchestration), and MagicWand (observability) to supplement DBQL analysis.Build end-to-end, log-driven analysis pipelines in Databricks to identify unused datasets, read-only (non-updating) datasets, and unused partitions within active datasets.Capture and analyze CPU/IO resource usage and workload statistics (ResUsage) to quantify cost-reduction opportunities.Classify data into cold, warm, and hot tiers; generate heatmaps of date/partition access patterns.Develop a prioritized recommendation backlog with expected savings, risk levels, and required changes.Apply AI/ML models or LLM-assisted analysis to detect access pattern anomalies, predict cold data candidates, and automate classification.Produce and present deliverables: Observation Report, Workshop Notes & Action Log, and Final Readout for customer 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