Job Search Results for healthcare payer

We are seeking a highly skilled and experienced Solution Architect to support enterprise-level initiatives with a focus on healthcare payer systems. The ideal candidate will bring a strong background... More in legacy systems, modern cloud technologies, and emerging AI capabilities to help design and guide scalable, secure, and innovative solutions.Collaborate with business and technical stakeholders to define solution architecture aligned with strategic goals.Design and document end-to-end solutions that integrate legacy systems with modern platforms.Provide architectural oversight and guidance throughout the project lifecycle.Evaluate and recommend AI and cloud-based tools to enhance business capabilities.Ensure compliance with healthcare regulations and data privacy standards.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 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

Job DescriptionAction Care Ambulance is seeking a detail-oriented and motivated Ambulance Biller to join their Centennial, CO office. This role supports billing for both emergency and non-emergency... More ambulance transports, working alongside dispatchers in the same building to ensure accurate data capture and claim submission. As a small organization that has recently begun using staffing partners, Action Care is focused on finding the right candidate who fits their culture, values, and workflow. Part-time is preferred, but full-time can be considered for the ideal person.Key Responsibilities? Utilize ZOLL billing software to enter, process, and manage ambulance billing data? Prepare, submit, and track claims for emergency and non-emergency transports? Review trip sheets, dispatch records, and run reports for billing accuracy? Verify patient information and supporting documents for claim completion? Ensure compliance with ambulance billing regulations and payer requirements? Communicate with dispatch and field crews when clarification is needed? Manage denials, follow-ups, and corrections to ensure timely reimbursement? Maintain accurate and confidential billing records? Support overall billing productivity and organizational workflowWe 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

he Manager of Hospital Revenue is responsible for overseeing all post-billing insurance follow-up activities for commercial payers to ensure timely, accurate, and complete reimbursement. This role... More provides strategic and operational leadership to a large, primarily remote team and ensures accounts progress from billing through final payment resolution. The Manager drives performance through KPI oversight, corrective action planning, and collaboration with internal stakeholders and external insurance partners.Key ResponsibilitiesRevenue Cycle & Insurance Follow-UpDirect and manage post-billing insurance follow-up for commercial insurance payers, including major national plans (e.g., Blue Cross, United Healthcare) as well as regional and smaller payers across the United States.Oversee the full lifecycle of insured accounts from post-billing through zero balance, ensuring all accounts are approved and paid in full.Maintain full responsibility for insurance-related accounts only; this role does not include self-pay or patient-balance management.Lead efforts to resolve payment variances, rejections, and denials by coordinating with insurance payers and internal hospital departments.Ensure compliance with payer policies, billing regulations, and organizational standards.Team Leadership & DevelopmentProvide direct leadership for a department of approximately 30 staff members, including two Assistant Managers and multiple payer-focused teams.Supervise Patient Account Specialists responsible for daily variance resolution, rejection handling, and denial management.Oversee Revenue Analysts who compile and analyze payer files and remittance data received from insurance companies.Manage a fully remote workforce, with approximately 90% of team members located locally, ensuring productivity, engagement, and accountability.Coach, mentor, and develop team members to improve performance, efficiency, and professional growth.Performance Management & KPIsOversee departmental performance through key performance indicators (KPIs) related to insurance follow-up, aging, denial resolution, and cash collections.Partner with Assistant Managers who monitor and report KPI performance; receive escalated reporting and trends for strategic oversight.Take ownership of corrective action planning and execution when KPIs fall below established targets.Use performance data to identify root causes, implement process improvements, and drive sustained results.Collaboration & Continuous ImprovementServe as a primary liaison with commercial insurance payers to address systemic issues, escalations, and reimbursement barriers.Collaborate closely with internal teams such as billing, coding, compliance, and clinical departments to resolve issues impacting reimbursement.Identify workflow inefficiencies and lead initiatives to improve accuracy, turnaround time, and overall revenue cycle performance.Support organizational revenue goals through proactive problem-solving and strategic decision-makingWe 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 Senior Revenue Integrity Analyst to support a Revenue Integrity department for a healthcare system in Annapolis. This individual will act as a subject matter expert for... More hospital charge capture, billing compliance, and revenue protection, working closely with clinical, coding, billing, and HIM teams to minimize revenue leakage and ensure compliant billing 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

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

As a Product Manager, you will define and drive the product vision and roadmap for a cloud based transactional data platform supporting enterprise healthcare applications. You will partner closely... More with senior stakeholders, architects, and engineering leaders to align platform capabilities with business objectives and downstream application needs.Daily, you will:?Own and evolve the product roadmap, balancing near term delivery with long term platform modernization and scalability goals?Define product outcomes, success metrics, and value propositions for platform capabilities supporting enterprise APIs and transactional data access?Collaborate with Product Owners and Agile teams to ensure roadmap priorities are translated into executable backlogs, epics, and features?Partner with engineering, data, and cloud teams to support data migration, cloud enablement, and platform stabilization efforts?Engage stakeholders across multiple domains to gather requirements, assess tradeoffs, and ensure alignment between platform direction and consumer needs?Support proofs of concept and phased releases, validating that solutions meet functional, performance, governance, and compliance expectations?Provide strategic guidance during Agile ceremonies, helping teams understand why work matters?not just what is being built?Identify risks, dependencies, and cross team impacts, proactively driving alignment and decision making to keep delivery on trackWe 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 looking for Utilization Review Registered Nurse to sit remotely with one of their large health insurance clients. This person will be responsible for evaluating 3.5 patient care... More cases per hour and collaborating with doctors, and other healthcare professionals. Day to day this individual will be assessing patient care requests for medical services (both inpatient and outpatient) and collaborating with providers to ensure the requested services align with medical necessity. It is critical that this person adheres to company policies regarding confidentiality and privacy. This person needs to pay very close attention to detail, be a team player, have flexibility in their day to day, etc. Being an expert within the plan and benefit template is crucial, and having great written and verbal communication is important!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 Genesys IVR Automation Tester will support enhancements to the existing enterprise Genesys application, with a focus on validating updates to IVR flows, routing strategies, and related... More integrations. This role is responsible for ensuring changes to the production environment maintain stability, performance, and alignment with operational requirements across multi-tenant, high availability architectures. Key Responsibilities:? Design, develop, and execute automated test scripts for enhancements to Genesys Cloud voice and IVR applications ? Validate updates to IVR flows, call routing logic, queues, CTI integrations, and API driven workflows ? Perform end to end testing of voice flows across SIP, telephony platforms, and backend systems ? Support regression and integration testing for releases and incremental platform improvements ? Partner with developers and architects to validate configuration changes across GAX, CIW, CME, and routing strategies ? Identify defects, document findings, and support root cause analysis and remediation ? Validate production readiness and support release stabilization as needed ? Contribute to automation framework improvements and testing best practicesWe 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 Genesys QA Tester will support enhancements to the existing enterprise Genesys platform as well as implementations for de novo clinics and newly acquired entities transitioning onto Genesys.... More These offshore roles, staffed at the Regular to Senior level, are responsible for ensuring high quality delivery across voice, IVR, routing, desktop, and integration capabilities during both expansion and migration efforts.Key Responsibilities:? Execute functional, integration, and regression testing for enhancements to the existing Genesys environment ? Validate new Genesys implementations for de novo clinic launches ? Support testing during migration of legacy telephony platforms to Genesys for acquired organizations ? Test IVR flows, routing strategies, queues, CTI behavior, and agent desktop functionality ? Validate API integrations between Genesys and backend systems ? Participate in system integration testing, user acceptance testing support, and release validation ? Log, track, and validate defect resolution in partnership with development teams ? Support cutover readiness, go live validation, and post deployment hypercare stabilizationWe 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