SIU Investigator Centene Corporation GroupSIU InvestigatorNJ$56,200–$101,000 / yearCollaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.
Special Investigation Unit Investigator Centene Corporation GroupSpecial Investigation Unit InvestigatorNY$56,200–$101,000 / yearEducation/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience (or) An Associates or Bachelor's degree in criminal justice or a related field; (or) employment as an investigator in the MMCO's SIU on or before the effective date of this SubPart required. Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters.
Director of Patient Access Services-Patient Financial Services-Corporate 42nd Street-Full-Time Days Mount Sinai Health SystemDirector of Patient Access Services-Patient Financial Services-Corporate 42nd Street-Full-Time DaysNew York, NY$127,044–$190,565 / yearCollaborating with hospital and physician leadership, this position works closely with Revenue Integrity, Coding, Billing, Cash Posting, and Case Management in defining vision, strategy and priority setting for system wide-revenue operations system initiatives, including: The integration and distribution of information that contributes to the capture, management, and collection of hospital patient service revenue using a holistic perspective to ensure that the business processes are operating in an integrated, efficient state to achieve maximum effectiveness; Improving business processes to maximize and protect the assets of the enterprise by enhancing and maintaining a properly functioning revenue cycle process through a cross-department organizational structure; Establishing and maintaining key revenue cycle performance indicators for the enterprise in support of BMC's strategic plan. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
NewVP, RCM Business Operations oneOncologyVP, RCM Business OperationsNew York, NY$180,000–$230,000 / yearJob Description: This individual will be responsible for helping coordinate the day-to-day execution of all RCM functions, working with the Chief Revenue Officer ("CRO") and the other RCM Vice Presidents to optimize performance, ensure proactive communication with practices, manage risks and issues along with the overall OO RCM team. OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases.
Applied AI Scientist, Clinical AI Agents R37 Lab, R1 RCMApplied AI Scientist, Clinical AI AgentsNew York, New YorkPhare Health is now part of R1 and its AI innovation engine, R37 Lab , bringing Phare’s frontier clinical reasoning technology together with one of the largest healthcare platforms in the U.S. At R37 and Phare, we are building the first AI-native Healthcare Revenue Operating System : a connected platform that reasons over full medical records, payer logic, and financial workflows to automate medical coding, billing, and follow-up. You will be embedded in hard healthcare problems — clinical documentation integrity, medical coding, denial prevention, appeals, revenue cycle workflows, and payer logic — and will own the loop from problem framing to agent design, evaluation, deployment, trace analysis, and ongoing improvement.
Assistant Director (FGP), Revenue Optimization & Analytics - Radiology, Manhattan NYU Langone HealthAssistant Director (FGP), Revenue Optimization & Analytics - Radiology, ManhattanNew York, NY$121,792.22–$210,091.64Full timeWork closely with departmental and revenue cycle leadership on initiatives that target revenue optimization for radiology services, including identifying bottlenecks, analyzing root causes, and implementing corrective measures. Regularly meet with Department Chair and his leadership team to present revenue cycle insights, address payor issues, and review opportunities for improvement using practice-specific and departmental data.
Employed Optometrist- New York, NY- LensCrafters EssilorLuxottica SAEmployed Optometrist- New York, NY- LensCraftersNew York, NY$65.19–$91.39 / hourIf you would like to provide feedback regarding an active job posting, or if you are an individual with a disability who would like to request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name, job id number, and contact information so that we may follow up in a timely manner) or email EmployeeRelations@luxotticaretail.com. LensCrafters is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions.
NewEd Business Associate | Full-Time Day Shift E/O Weekend (25516) Bergen New Bridge Medical CenterEd Business Associate | Full-Time Day Shift E/O Weekend (25516)Paramus, New JerseyArranges for the efficient and orderly admission of patients presenting to the Emergency Department, ensuring that all required patient information pertinent to registration is obtained and accurately entered into the EMR per EMTALA and HIPAA compliance regulations. Admits, discharges and transfers patients to and from units such as Emergency Room, Skilled Nursing Facility, Psychiatric Services, SDS, etc.
Clinical Nurse Reviewer Zelis Healthcare, Inc.Clinical Nurse ReviewerMorristown, NJ$59,000–$75,050 / yearThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Emergency Dept. Business Associate - Per-Diem (25199) Bergen New Bridge Medical CenterEmergency Dept. Business Associate - Per-Diem (25199)Paramus, New JerseyArranges for the efficient and orderly admission of patients presenting to the Emergency Department, ensuring that all required patient information pertinent to registration is obtained and accurately entered into the EMR per EMTALA and HIPAA compliance regulations. Admits, discharges and transfers patients to and from units such as Emergency Room, Skilled Nursing Facility, Psychiatric Services, SDS, etc.
Full Time - Medical Scribe - Church Ave Sun River Health IncFull Time - Medical Scribe - Church AveBrooklyn, NY$20.50–$23.56 / hourUnder the supervision of the VP of Practice Management, the medical scribe will be responsible for capturing accurate and detailed documentation of the medical encounter into the Electronic Medical Record (eClinical Works) in a timely manner. Attend trainings on diverse subjects such as information technology, legal, HIPAA and regulatory compliance, billing and coding, proofread and edit all the physician's medical documents for accuracy, spelling, punctuation, and grammar.
NewClaims Specialist- Liab Crawford & CoClaims Specialist- LiabBerkeley Heights, NJTo determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim.
Care Manager (Clinical) [CMA] Guideway Care, Inc.Care Manager (Clinical) [CMA]NYUsing computer applications Making and answering phone calls the majority of the shift Welcoming patients Reviewing patient medical records Coding and filling out insurance forms Scheduling appointments Arranging for hospital admissions and laboratory services Handling correspondence, billing, and bookkeeping Escalating patient concerns or needs to appropriate provider. Essential Functions: (may include, but not limited to): Manage and support patients' healthcare needs via telephonic outreach Conduct and document visits by using several technology platforms and EHRs Monitors adherence to care plans, evaluates effectiveness, monitors patient progress in a timely manner, and facilitates changes as needed.
Product Security Engineer Candid HealthProduct Security EngineerNew York, NY$180,000–$258,000 / yearMedical billing is expensive because it's nuanced and hard - maybe ~100x harder than credit card payment processing - and because it's traditionally done by armies of humans who track and manage complex rules and processes specific to individual insurance companies with little or no supporting software. We're rethinking medical billing from the ground up, building software backed by best-in-class data science (and, soon, a dash of machine learning) to automate much of this complexity so healthcare providers can get paid dramatically more easily and inexpensively.
NewOncology Authorization Specialist St. Joseph's Healthcare SystemOncology Authorization SpecialistPaterson, NJThe combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care". Key responsibilities include verifying insurance coverage, obtaining necessary authorizations, and providing clear cost estimates to patients, thereby promoting transparency and reducing financial uncertainty.
NewPre Service Rep - Patient Access Central - Full Time Day Shift (23944) Bergen New Bridge Medical CenterPre Service Rep - Patient Access Central - Full Time Day Shift (23944)Paramus, New JerseyThe preservice representative assures that all patients have all information they need so that they will arrive on time and prepared for their appointment and the hospital has all the information required to properly bill or services. Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.
Director, Provider Education & Risk Adjustment Metropolitan Jewish Health SystemDirector, Provider Education & Risk AdjustmentNew York, New YorkFull timeThey are responsible for implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. • Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.
Community Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET) AnewHealthCommunity Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET)NJRemoteAbility to communicate effectively and professionally through written, verbal (e.g., face-to-face, telephonically and/or virtual communication platforms), and interpersonal skills as applied when interacting with employees, patients, healthcare professionals, clients, or agency representatives; successfully conveying and exchanging information at an appropriate level and in a positive and timely manner. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly.
Mgr - Multi-Facility CDI - SMNJ Medical Records FAC#1 Saint Michaels Medical CenterMgr - Multi-Facility CDI - SMNJ Medical Records FAC#1Newark, New JerseyFull timeCombining state-of-the-art technology, the latest diagnostic and therapeutic procedures, leading-edge research, and a network of highly qualified physicians, nurses, and allied health professionals, the hospital provides top-quality health care services delivered with compassionate care. Established by the Franciscan Sisters of the Poor in 1867, Saint Michael's Medical Center is a 358-bed regional tertiary-care, teaching, and research center in the heart of Newark's business and educational district and is accredited by The Joint Commission.
Remote Pediatric Medical Coder - PICU / Neonatology (ProFee) UCSF Medical CenterRemote Pediatric Medical Coder - PICU / Neonatology (ProFee)NYRemote$50.61–$63.01 / hourThe University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. Resolve Claims Manager and Epic edits to ensure correct coding of services provided, including review of documentation for correct coding, evaluation and management (E/M) leveling, diagnosis coding, bundling issues, and modifier usage.