Job Search Results for healthcare payer

Insight Global is seeking a Medical Staff Credentialing & Provider Enrollment Specialist for a top academic healthcare client. This individual will play a critical role in onboarding and maintaining... More clinical faculty by managing medical staff credentialing, applications and third-party payer enrollment. The role partners closely with physicians, managed care teams, and practice plan administration to ensure all applications, documentation, and regulatory requirements are completed accurately and on time. This is an excellent opportunity for a detail-oriented credentialing professional who thrives in a fast-paced, highly regulated healthcare environment and enjoys being a key resource for new physician hires.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 Patient Account Follow Up Representative is responsible for post billing insurance follow up to ensure accurate and timely reimbursement. This role works claims after they have been received by... More the payer and focuses on resolving underpayments, denials, and coordination of benefits issues. Representatives communicate directly with insurance carriers and patients regarding co pays, deductibles, denials, and coverage discrepancies while delivering excellent customer service. The representative verifies insurance eligibility and benefits as needed, navigates Epic to review registration details, claim history, and account activity, and uses FinThrive for claims clearing and follow up workflows. This role requires timely and accurate account resolution, clear documentation, and consistent interaction with payers, patients, and internal teams to meet productivity and quality standards. The team is fast paced, so candidates should be prepared to resolve approximately 49 claims/denials per day. There are three open roles in the below focus areas:?AmeriHealth / IBX (Commercial Payers): Follow up on commercial insurance claims, including AmeriHealth, IBX, Horizon, Aetna, and regional plans.?Medicaid: Follow up on Medicaid claims with an emphasis on eligibility, coverage, and payer specific requirements.?Denials & Underpayments: Research and resolve denied and underpaid claims across multiple payer types, including root cause analysis.Main Job Duties: ?Verify eligibility with insurance companies.?Communicate with patients and insurance companies regarding co-pays, deductibles, denials, and Cost of Benefit (COB) issues.?Resolve accounts timely and effectively.?Provides excellent customer service.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

We are seeking a detail-oriented and execution-focused Product Owner to support the delivery of features and enhancements within the healthcare claims administration platform. This role is... More responsible for?translating business and stakeholder needs into clear, actionable user stories that address both functional requirements and non-functional considerations such as performance and scalability,?and working closely with engineering teams to ensure timely, high-quality delivery. The ideal candidate brings healthcare domain knowledge, understands Agile processes, and is comfortable using AI-enabled tools to support requirements definition and backlog management.Backlog Ownership & Agile Execution?Own and manage the product backlog, ensuring stories are well-defined, prioritized, and aligned with sprint goals?Write epics, user stories, and acceptance criteria that are clear, testable, and customer-centric?Refine non-functional requirements (NFRs) and ensuring acceptance criteria reflects scaling and performance expectationsConduct regular backlog grooming and sprint planning in collaboration with the Scrum team?Participate in daily standups, sprint reviews, and retrospectives as an active team member?Ensure user stories meet the definition of ready and done before development and release?Requirements Gathering & User Story Development?Collaborate with stakeholders, subject matter experts, and internal teams to gather and refine product requirements?Use AI tools (where applicable) to support the creation of epics, themes, and user stories?Conduct gap analysis and validation of requirements to ensure completeness and feasibility?Support refinement of use cases, workflows, and functional documentation?Cross-Functional CollaborationServe as the primary point of contact for development teams during sprint execution?Partner with UX/UI designers to ensure user stories are aligned with design principles and usability goals?Support QA teams by clarifying acceptance criteria and reviewing test cases as needed?Participate in production demos and release reviews as neededCoordinate with other Product Owners to manage interdependencies between features?Customer & Stakeholder Engagement?Participate in stakeholder meetings to capture feature requests, enhancement ideas, and feedback?Communicate updates to internal stakeholders on backlog priorities, delivery timelines, and sprint progress?Track SLO/SLA adherence for features within your scopeHelp ensure features delivered meet customer needs and stakeholder expectations?Healthcare Domain Support?Apply working knowledge of healthcare claims workflows, billing terminology, and reimbursement processes?Support compliance with healthcare regulations (HIPAA, HITECH) in collaboration with internal teams?Assist in translating complex healthcare requirements into understandable product featuresWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Our client is seeking a SQL / Power BI Developer to support enterprise-level claims reconciliation, audit controls, and data visibility across critical healthcare systems. This role focuses on... More ensuring financial accuracy, compliance, and traceability across the end-to-end claims lifecycle.You?ll work within Sentara?s existing Azure/Databricks data environment, partnering with data, claims, and business teams to analyze, reconcile, and visualize data moving across multiple systems.This resource will be responsible for: -Building Power BI dashboards that support audit, balancing, and reconciliation controls-Using SQL to reconcile claim counts and dollar amounts across upstream and downstream systems-Working with data housed in Databricks to support analytics and reconciliation reporting-Tracing claims data end-to-end (inbound EDI ? internal processing systems ? outbound Medicaid submissions and response files)-Validating total paid amounts, volumes, and financial accuracy across the claims pipeline-Investigating discrepancies and data variances with business analysts and claims teams-Supporting existing ETL and data ingestion processes and ensure analytical outputs align with source data-Pay rate between $50-57/hrWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

A healthcare payor client is seeking a highly experienced MDM Architect to support and evolve their existing Informatica Master Data Management (MDM) platform within their complex enterprise data... More environment. This role will focus on optimizing and scaling the current MDM solution, supporting new data integration initiatives, and preparing the platform for future transformation or migration.The ideal candidate brings strong experience in MDM architecture, data integration, and data standardization for golden records of healthcare specific data (i.e. member/provider). Key responsibilities include: Architecture & Solution Design (40%) ? Design and enhance MDM/Reference Data architecture supporting enterprise data initiatives? Define solutions for onboarding new data sets and expanding MDM coverage? Support future-state planning, including potential MDM platform migration? Establish and maintain data architecture standards and best practices? Partner with Enterprise Data Office, engineering teams, and business stakeholders? Translate business requirements into scalable data architecture solutionsPlatform Optimization & Support (30%) ? Optimize performance and scalability of the existing Informatica MDM platform? Serve as the technical escalation point for complex MDM/data issues? Identify and implement enhancements to improve data quality and system efficiency? Ensure stability of production MDM and data integration processesData Integration & Engineering Oversight (20%)? Design and guide data movement pipelines across: ? On-prem systems (SQL Server, etc.)? Azure cloud environment? Support ETL development, SQL processes, and job automation? Oversee integration of member and provider data into centralized MDM platformData Governance & Quality(10%) ? Support creation and maintenance of golden records (member & provider)? Guide data quality, reconciliation, and integrity processesImprove data accessibility, consistency, and reusability across the organizationWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

We are actively hiring an experienced Procedure Scheduler to support a high-volume cardiology practice. This role is responsible for coordinating and scheduling surgical procedures, cardiology... More testing, and specialty consultations while ensuring a positive patient experience and smooth provider workflows.Key Responsibilities? Maintain a positive, professional, and patient-centered approach with patients, physicians, and staff.? Respond promptly and accurately to requests from physicians, practice administrators, and team leads.? Maintain punctuality, reliable attendance, and compliance with all office policies and procedures.? Exercise sound judgment in support of practice goals and high-quality patient care.? Adhere strictly to HIPAA regulations and patient confidentiality standards.? Coordinate and schedule cardiology procedures, diagnostic testing, and consultations based on physician direction and patient needs.? Communicate with patients regarding scheduling details, preparation instructions, and pre-authorization requirements.? Serve as a primary point of contact for patients, addressing questions, concerns, and providing ongoing support.? Maintain clear, thorough, and accurate documentation for all patient-related correspondence.? Enter and maintain current patient information and records within eClinicalWorks.? Collaborate closely with cardiologists, APPs, and internal/external healthcare partners to optimize scheduling efficiency.? Adjust and reschedule physician calendars as directed by the practice manager or team lead.? Review daily schedules to identify gaps, conflicts, or errors and implement necessary corrections.? Verify patient insurance eligibility and coverage.? Obtain required pre-authorizations for cardiology procedures in accordance with payer guidelines.? Monitor messages throughout the day, ensuring information is complete and detailed for physician review.? Maintain awareness of applicable healthcare regulations, policies, and guidelines impacting scheduling and patient care.? Support overall clinic operations to ensure efficient workflow.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 a Product Manager for a top healthcare analytics and payment integrity client. The work authorization is not specified and the rate is between $110,000-$130,000. This... More individual will join an AI-first product team focused on shifting Coordination of Benefits from traditional retrospective recovery into proactive, pre-pay prevention. The role sits at the intersection of revenue cycle, eligibility, clearinghouse capabilities, and modern AI tooling?supporting automated cost avoidance and improved accuracy across health plans and providers. This is an accelerated growth opportunity for a product-minded professional eager to experiment, build interactive AI agents, and help scale a hardened, enterprise-grade COB platform with real financial and operational impact.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

The Director of Cash Applications is responsible for overseeing cash posting, refunds, and cash reconciliation operations for a multi-hospital health system. This role requires a strong understanding... More of the full revenue cycle, along with a solid analytical and financial reporting background. The Director must be capable of monitoring employee productivity, maintaining human resources documentation, resolving technical and payer-related issues, and ensuring compliance with organizational policies and procedures.Responsibilities:- Oversee all cash application functions, including but not limited to cash posting, refunds, and reconciliation activities- Manage staff quality, productivity, and output benchmarking; perform regular staff quality assurance audits- Design and develop financial reports using various tools to support tracking, investigation, and analysis, and to inform organizational decision-making- Monitor and evaluate the organization?s revenue cycle performance; appropriately delegate work based on departmental priorities and operational needs- Collaborate with internal and external partners such as IT, financial clearinghouses, Finance, and banking partners to identify process improvement opportunities; address issues and implement effective business strategies to reduce costs, increase revenue, and streamline expenditures, taking appropriate remediation actions as needed- Manage projects and delegate responsibilities accordingly- Onboard new team members, providing hands-on, elbow-to-elbow support during the onboarding processWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

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

Job Description: Insight Global is seeking a Manager, Data Governance for a large, complex enterprise organization operating across healthcare, insurance, and academic domains. This individual will... More play a pivotal role in building and leading an enterprise-wide data governance program from the ground up. The ideal candidate is a strong change agent with executive-level communication skills who can establish governance standards, educate leaders, and drive adoption across diverse business lines. This is a long-term, high-impact leadership role focused on creating sustainable data quality, ownership, and governance practices that enable responsible AI, analytics, and enterprise decision-making.Responsibilities: ?Lead the enterprise data governance strategy across three domains: oHealthcareoInsuranceoUniversity (Academics)?Establish foundational governance in a largely green environment?Define and implement: oData domainsoData stewardship and ownershipoDecision rights and escalation pathsoData quality and exchange standards (internal & vendor-based)?Educate business leaders, clinicians, and academic stakeholders on governance principles?Build and lead governance councils and working groups?Manage and mentor a team of 3-4 individuals new to governance, help build out additional team ?Partner with IT and data teams to deploy governance tooling (Purview, Azure stack)?Ensure data readiness before expanded AI initiatives?Drive long-term, continuous governance implementation (approx. 3-year maturity horizon)?Report progress, investment value, and outcomes to enterprise leadershipWe 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