Job Search Results for healthcare payer

As a Government Payer Program Manager, you will serve as the primary point of accountability for all government payer programming. A newly created role driven by the award of a significant new... More government contract. You will lead projects from start to finish across various business units, managing deliverables that support government payer relations through internal teams, resource development, stakeholder communication, risk management, and quality assurance. The ideal candidate demonstrates proficiency in tailoring best practices, overseeing multiple concurrent initiatives, and partnering closely with cross-functional internal stakeholders including Executive leadership as well as external government and third-party payer partners.This role carries direct oversight of payer relations with governmental agencies including Veterans Affairs (primary focus), Medicare, State Medicaid, Medicare Advantage, Managed Medicaid, and TRICARE. Successful candidates must be analytical, solution-oriented, flexible, and engage positively with stakeholders at all levels. The ideal candidate has built government payer programs before and thrives in environments with ambiguity and growth. This role with have no direct reports.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

A healthcare payor client is hiring for a highly analytical and process-driven Data Quality & Governance consultant to spearhead the integrity and usability of their enterprise data assets. This is a... More hybrid role that demands a unique blend of technical data profiling expertise and strategic oversight. The ideal candidate will be a Collibra power user who views data governance not just as a set of rules, but as a technical framework for ensuring "high-fidelity" data across the organization. You will be responsible for the end-to-end data lifecycle?from defining metadata standards to building automated quality dashboards and leading our Stewardship/quality ceremonies. Core Job Functions Include: DATA QUALITY: ? DQ Automation: Design and implement automated data quality rules and monitoring within the Collibra Data Quality & Observability module.? Profiling & Remediation: Conduct deep-dive data profiling to identify anomalies, duplicates, and inconsistencies. Work directly with technical teams to resolve root-cause issues in data pipelines.? Metric Development: Establish and track DQ KPIs (Accuracy, Completeness, Consistency, Timeliness, Validity, and Uniqueness) for critical data domains.? Standardization: Manage the reconciliation of legacy data into standardized canonical models, ensuring vendor and internal data alignment (e.g., NPI or provider data reconciliation).DATA GOVERNANCE ? Collibra Stewardship: Act as the primary administrator for the Collibra Data Intelligence Cloud, managing the Business Glossary, Data Catalog, and Lineage.? Council facilitator: Facilitate the Data Governance Council meetings, translating technical DQ findings into actionable business decisions for executive stakeholders.? Change Management: Act as a diplomat between IT and Business units to foster a "quality-first" data culture.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

A nonprofit healthcare organization serving the Dallas Fort Worth community. The organization has approximately 230 employees and partners with local health systems. The mission focuses on community... More based care, compliance, and data driven decision making. The Director of Healthcare Informatics and Analytics leads the organization?s analytics, informatics, and reporting function. Reports directly to the VP of IT. Leads a two person informatics and analytics team. This role owns the accuracy, credibility, and delivery of healthcare data used by senior leadership. The Director is both a hands on technical contributor and a people leader. The primary focus is rebuilding trust in data and establishing consistent, reliable reporting practices.Key Responsibilities:Data Governance and LeadershipLead the Data Governance Committee and define reporting standards.Establish consistent KPI definitions and validation processes.Create standard operating procedures for analytics and reporting.Rebuild trust with leadership by improving data accuracy and reliability.Mentor and support a small, cross functional team.Analytics and Executive ReportingDevelop and maintain enterprise dashboards using Power BI.Deliver reporting on revenue, payer mix, and operational performance.Answer executive questions related to Medicare, private pay, and claim conversion.Validate all data before release to senior stakeholders.Technical and Data Engineering WorkWork directly in Snowflake to prepare and model data.Write and optimize SQL queries for reporting and analytics.Partner with IT on data pipelines and integrations.Investigate and resolve data discrepancies across systems.Healthcare and Pharmacy InformaticsSupport Athena EMR reporting and data workflows.Partner with pharmacy leadership on PioneerRx reporting.Provide analytics related to prescription distribution and 340B eligibility.Support required healthcare reporting such as UDS and MIPS.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Insight Global is seeking a Supervisor of Accounts Receivable specifically for Third Party Follow Up with Horizon Blue Cross Blue shield for a top healthcare network client. This individual will lead... More a team responsible for third-party payer follow-up, denial management, and claims resolution across government, managed care, and commercial payers. The ideal candidate is a hands-on leader with strong revenue cycle expertise, experience navigating complex payer requirements, and the ability to drive operational efficiency while supporting and developing staff. This role plays a critical part in ensuring timely reimbursement and improving overall financial performance within a large, mission-driven healthcare organization.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Insight Global is seeking an experienced Revenue Cycle Strategy Manager to lead the strategic direction and optimization of revenue cycle performance for a high-volume healthcare walk-in center. This... More role is highly strategy-forward, with significant exposure to executive leadership, and plays a critical role in driving financial sustainability, compliance, and operational efficiency within a predominantly Medicaid payer environment (approximately 80%).This individual will serve as a thought partner to clinical, operational, and financial leaders?using data, payer insight, and process design to influence decision-making and strengthen revenue outcomes across the organization.Key Responsibilities- Provide strategic oversight of the end-to-end revenue cycle, with a primary focus on back-end functions including eligibility, credentialing, coding, billing, claims, collections, and targeted denial management.- Partner closely with executive leadership, operations, and clinical teams to align revenue cycle strategy with care delivery models, growth initiatives, and regulatory requirements.- Lead and develop a team of 7?10 revenue cycle professionals, establishing accountability, performance expectations, and continuous improvement practices.- Serve as the subject matter expert for governmental payers, with deep expertise in Medicaid programs, reimbursement structures, and payer behavior.- Analyze trends in payer performance, reimbursement patterns, and denial drivers to inform strategic recommendations and operational adjustments.- Own and monitor key revenue cycle KPIs (e.g., cash flow, AR days, first-pass resolution), translating data into actionable insights for leadership.- Oversee quality assurance and governance across credentialing, payer selection, eligibility verification, and claims submission to ensure accuracy, compliance, and scalability.- Provide high-level guidance on complex coding and billing scenarios, ensuring appropriate modifier usage and regulatory alignment.- Identify opportunities for process optimization, automation, and workflow redesign to improve efficiency and financial outcomes.- Act as a strategic problem solver, proactively addressing risks and opportunities within the revenue cycle landscape.This is a hybrid role out of Scottsdale, AZ. Salary ranges between $115-120k base + bonus, with total annual take home opportunity at $140k. Candidate will be eligible for medical, dental, and vision benefits through the client directly, as this is a permanent position.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 qualified Product Manager in support of one of our large healthcare clients. This candidate will be responsible for defining product vision, managing the product roadmap,... More and aligning stakeholders across business and IT teams. Their day to day will include managing backlog readiness, prioritizing incoming work, coordinating across Agile teams, and ensuring delivery aligns with business outcomes. A qualified candidate will have experience with Agile frameworks, healthcare payer systems, and managing product lifecycles in complex integration environments.- Defining product vision, strategy, and roadmap - Managing intake, prioritization, and backlog readiness- Owning portfolio and feature epics within Agile framework - Partnering with Product Owners and Scrum Masters on delivery - Assessing demand vs. capacity and driving prioritization decisions - Managing risks, dependencies, and cross-team coordination - Defining acceptance criteria and ensuring successful delivery outcomes - Providing weekly reporting, roadmap updates, and stakeholder communicationWe 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 DescriptionThe Director of Patient Financial Services provides strategic leadership and oversight of healthcare receivables operations, including patient registration, billing, accounts... More receivable, cash management, and financial reporting. This role is responsible for optimizing revenue cycle performance, ensuring regulatory compliance, and driving accurate claim submission and timely reimbursement across the organization.The Director will lead a combined team of approximately 75 staff across multiple locations and will partner closely with operational and executive leadership to improve financial outcomes. This role leverages deep expertise in hospital billing, reimbursement, and financial eligibility to resolve complex issues, analyze performance trends, and implement process improvements aligned with organizational goals.Key ResponsibilitiesProvide strategic and operational leadership for all healthcare receivables functions, including billing, AR, cash management, and reportingDirectly manage and develop management teams overseeing approximately 75 staff across hospital and Cape Regional operationsEnsure compliance with federal, state, payer, and industry regulationsAnalyze and resolve complex claim submission and reimbursement issues across departmentsUtilize Epic to support enterprise billing, AR workflows, and reportingOversee budgeting, forecasting, auditing, AR and reserve analysis, and financial performance reportingMonitor healthcare financial indicators and lead continuous improvement initiativesWe 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 a Home Health Clinical Manager for a client based in Owings Mills MD. The clinical manager will be providing support for overall planning, direction, coordination,... More management, and supervision of all nursing and professional services in conjunction with the Director of Clinical Services. Assures quality of care by reviewing and assessing each service. She/he also monitors the outcomes of clinical service activity by evaluating the performance of clinical staff, ensuring compliance with all agency policies and procedures and regulatory standards, coordinating agency committees, and monitoring the effective and efficient use of budgeted resources (personnel, supplies, equipment).Responsibilities:-Keeps Clinical Director informed on all events which occur involving patients and ordered health services.-Responsible for clinical oversight of clinical services-Advises the Clinical Director as to the basis of the need for additional health services to be provided.-Provides the Clinical Director with statistical data involving patients and clinical services areas when requested.-Develops, evaluates, reviews, revises, and implements policies and procedures; goals and objectives; and standards of care relevant to clinical services and personnel functions.-Ensures clinical documentation is accurate, complete, timely, and compliant with all federal, state, and accreditation standards. Ensure clinical documentation is free of errors that would prevent billing.-Ensures excellent levels of patient satisfaction through clinician education, review of patient feedback, and corrective actions.-Addresses and supports cultural practices, if such practices do not harm others or interfere with the planned course of medical therapy.-Coordinates all patients? services by reviewing plans of treatment, assuring case conferences are conducted, reviewing clinical and progress notes, periodic patient evaluations and determining frequency and/or staffing patterns.-Oversees Agency coding function to ensure coding is appropriate, timely, and compliant.-Supports the Clinical Director with any prescribed activities, investigation, documentation, education, or training as requested-Aids in the Agency?s goal of retaining quality personnel by appropriately hiring, orienting, training, evaluating and disciplining personnel within established policy.-Ensures personnel are scheduled to ensure proper coverage within authorized staffing levels.-Ensures orientation and ongoing training programs are developed and provided for therapy personnel.-Ensures personnel receive timely, complete, and documented orientation and training.-Conducts performance evaluations in a timely, measurable, and objective manner. Communicate this information to the Clinical Director.-Maintains a working knowledge of current Medicare, Medicaid and third-party payer requirements for home care reimbursement and have a proficient and in-depth knowledge of current OASIS dataset.-Communicates and coordinates with physician?s offices, payers, patients/families, outpatient services and inpatient coordinator, regarding the care and status of the patient.-Keeps up to date on new methods, products, trends, etc., and communicates this information to personnel.-Participates in the agency?s information management and performance improvement programs.-Supports and complies with the agency?s policies.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 an experienced Senior Data Engineer with deep expertise in health plan / managed care environments to design, develop, and maintain enterprise-grade data solutions. This role will... More support critical healthcare operations and analytics by working with QNXT replicated databases, Oracle platforms, and complex SQL-based data transformations in a Unix/Linux environment.The ideal candidate has hands-on experience supporting payer systems, understands healthcare data models (claims, eligibility, providers, members), and can work independently in a highly regulated environment.Key ResponsibilitiesDesign, develop, and optimize scalable data pipelines and data models supporting healthcare and managed care use casesWork extensively with Oracle databases, including performance tuning, query optimization, and data integrity managementDevelop and maintain complex SQL, PL/SQL, and T-SQL scripts, procedures, functions, and packagesSupport and manage data extracted from QNXT replicated databases, ensuring accuracy, timeliness, and reliabilityCollaborate with business, analytics, and reporting teams to translate health plan requirements into technical solutionsPerform root-cause analysis and resolve data quality, performance, and integration issuesOperate within Unix/Linux environments, including scripting, scheduling, and job monitoringEnsure compliance with healthcare data governance, security, and regulatory standards (HIPAA, PHI handling)Provide technical guidance and mentorship to junior engineers as neededWe 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