Director, Payment Integrity Capital Rx, Inc.Director, Payment IntegrityCharlotte, NC$206,400–$258,000 / yearPosition Summary: The Director, Payment Integrity will build and lead Judi Health's payment integrity program from inception, establishing the infrastructure, processes, and team that will ensure claims are paid correctly, compliantly, and efficiently across our commercial plan population. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
Director, Payment Integrity Judi HealthDirector, Payment IntegrityCharlotte, North Carolina$206,400–$258,000 / yearThe Director, Payment Integrity will build and lead Judi Health's payment integrity program from inception, establishing the infrastructure, processes, and team that will ensure claims are paid correctly, compliantly, and efficiently across our commercial plan population. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
Director, Payment Integrity Capital Rx LLCDirector, Payment IntegrityCharlotte, NC$206,400–$258,000 / yearPosition Summary: The Director, Payment Integrity will build and lead Judi Health''s payment integrity program from inception, establishing the infrastructure, processes, and team that will ensure claims are paid correctly, compliantly, and efficiently across our commercial plan population. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
Forward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_Transformation DeloitteForward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_TransformationCharlotte, NC$105,400–$207,800 / yearWorking knowledge of the retrieval and knowledge layer behind agentic systems - RAG pipelines, embeddings and vector stores, and increasingly knowledge graphs - including how to ground use cases in large volumes of unstructured healthcare data (e.g., clinical notes, payer policies, contracts) alongside structured sources. Partner with Health Care consulting teams and Converge for Healthcare's account and product teams during the sales cycle - running technical discovery, demonstrations, and use-case fit assessments - such as denial prevention, prior authorization automation, or AR follow-up - that qualify client needs and shape a credible path to production value.
ABA Clinical Reviewer TriWest Healthcare AllianceABA Clinical ReviewerCharlotte, NCRemoteFull timeIndependent Thinking / Self-Initiative: Critical thinker with the ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources. General knowledge of TRICARE or other government health care programs; Knowledge in the application of clinical criteria: InterQual, ICD-10-CM, DSM, and CPT coding; Proficient with Microsoft Office.
Forward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_Transformation Deloitte Touche Tohmatsu LtdForward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_TransformationCharlotte, NC$105,400–$207,800 / yearWorking knowledge of the retrieval and knowledge layer behind agentic systems - RAG pipelines, embeddings and vector stores, and increasingly knowledge graphs - including how to ground use cases in large volumes of unstructured healthcare data (e.g., clinical notes, payer policies, contracts) alongside structured sources. Partner with Health Care consulting teams and Converge for Healthcare's account and product teams during the sales cycle - running technical discovery, demonstrations, and use-case fit assessments - such as denial prevention, prior authorization automation, or AR follow-up - that qualify client needs and shape a credible path to production value.
Lead, Medical Network Claims Pricer Capital Rx, Inc.Lead, Medical Network Claims PricerCharlotte, NC$128,000–$160,000 / yearApply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules; resource-based relative value methodologies; diagnosis-related groups; ambulatory payment classifications; per-diem, case-rate, percent-of-charge, and other medical reimbursement arrangements.
NewUrgent hiring for 100 % Remote role of Clinical Document Improvement Specialist BuzzclanUrgent hiring for 100 % Remote role of Clinical Document Improvement SpecialistMorganton, NCRemotePerform concurrent reviews of inpatient acute-care medical records to ensure documentation accurately reflects the patient's clinical condition and services provided . Inpatient coding experience is beneficial as an additional background but does not replace the required 3 years of inpatient CDI Specialist experience .
NewLead, Medical Network Claims Pricer Judi HealthLead, Medical Network Claims PricerCharlotte, North Carolina$128,000–$160,000 / yearApply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules; resource-based relative value methodologies; diagnosis-related groups; ambulatory payment classifications; per-diem, case-rate, percent-of-charge, and other medical reimbursement arrangements.
Supervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementCharlotte, NCRemoteFull timeTechnical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.
Lead, Medical Network Pricer Capital Rx LLCLead, Medical Network PricerCharlotte, NC$128,000–$160,000 / yearApply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules; resource-based relative value methodologies; diagnosis-related groups; ambulatory payment classifications; per-diem, case-rate, percent-of-charge, and other medical reimbursement arrangements.
Medicaid Eligibility Analyst- Duke Lake Norman Duke UniversityMedicaid Eligibility Analyst- Duke Lake NormanMooresville, NCGather and provide necessary verifications to establish Medicaid eligibility via direct contact with patient and/or patients family, employer, financial institution, vital statistics and other collaterals to the County Department of Social Services Income Maintenance Caseworker in the county of patient residency. Prepare hearing briefs, assemble documentary evidence and exhibits to represent the patient at local agency, State and Chief Hearing Officer hearings for the purpose of reversing a negative decision with or without the patients assistance.
NewRemote Clinical Documentation Specialist Pride GlobalRemote Clinical Documentation SpecialistMorganton, NCRemote$1,600 / weekThis applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793. Only applicable for San Francisco Candidates : Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.
Accounts Receivable Representative OrthoCarolinaAccounts Receivable RepresentativeCharlotte, NCThe role of Accounts Receivable (AR) Representative with our team, you will be responsible for reviewing aging medical insurance account balances and resolving claim issues with insurance and/or patient. We are currently searching for an Accounts Receivable Representative (Medical Billing) to join our Revenue Cycle team in the OrthoCarolina Business Office in Charlotte.
Nurse Practitioner - PPV CompassusNurse Practitioner - PPVGaffney, SCThe Nurse Practitioner, if providing hospice care, functions as an extension of the interdisciplinary team (IDT) and hospice physician to provide routine recertification and emergency assessments, educational, and evaluative services to meet the needs of patients and their families. If providing Hospice Face to Face Visits: Performs routine and emergency assessments: Completes routine and emergency recertification visits on each patient entering their 3rd benefit period or beyond (including admissions and transfers).
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNCharlotte, North CarolinaOther: Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
Advanced Inpatient Coder Specialist (REMOTE) BayCare Health SystemAdvanced Inpatient Coder Specialist (REMOTE)Charlotte, NCRemoteResponsibilities: The Medical Records Advanced Inpatient Coding Specialist analyzes the multi day, multi-specialty complex documentation for inpatient encounters to assign integrated diagnosis and procedural code using ICD-10-CM and ICD-10-PCS coding systems. Serves as a liaison to Clinical Documentation Specialist Team and Quality Department for ICD-10 inpatient encounters for accurate code and MSDRG assignments as well as PSI/HAC reviews.
Registered Nurse/MDS Coordinator IMCS Group IncRegistered Nurse/MDS CoordinatorCharlotte, NCProcesses Skills REQUIRED: Admission Criteria, Appeals and Denials, Audits, Benefits Eligibility, Care coordination, Clinical Documentation Improvemen, Determine Medical Necessity per Evidence-Based Guidelines, Discharge Planning, Needs Assessment/ Order DME, Needs Assessment/Home Health, Needs Assessment/Hospice, Needs Assessment/Skilled Nursing, Physician Advisor, Plan of Care, Pre-Cert Review, Prior Authorizations, QI/ CASPER Review & Retrospective Review. -MDS is an integral part of the unit and is responsible for MDS completion, baseline care plan completion and presentation to residents, care plan meeting, carpe plan development and CAA completion, submission and validation of assessments, oversite of cert/recert process, properly dx code for new admissions, education MDS changes and triple check/ utilization review ensuring UB04 is properly completed and validated for release.
NewField Reimbursement Manager North Carolina CSL BehringField Reimbursement Manager North CarolinaCharlotte, North CarolinaWe use three strategic scientific platforms of plasma fractionation, recombinant protein technology, and cell and gene therapy to support continued innovation and continually refine ways in which products can address unmet medical needs and help patients lead full lives. Implements and maintains a variety of operational functions in support of the sales force, such as territory alignment, monitoring the sales effort within territories; periodically publishing sales activity reports of various territories, districts, or regions.
Clinical Data AMS Sr. Consultant DeloitteClinical Data AMS Sr. ConsultantCharlotte, NC$120,200–$140,000 / yearThis role owns the health, stability, and compliance posture of a suite of clinical and regulatory R&D platforms - including Axway Secure Transport (ST), eClinical Elluminate, Eclipse (medical coding), and EAST - across the full engagement lifecycle: implementation, configuration, validation, and steady-state managed services. The team operates at the intersection of IT infrastructure, clinical operations, and quality/regulatory compliance, partnering closely with global business and technology stakeholders to support end-to-end clinical trial data lifecycles from data capture and coding through statistical analysis and submission-ready outputs.