Outpatient Auditor Manager ExlService Holdings IncOutpatient Auditor ManagerNYRemote$105,000–$115,000 / yearThe role directly manages auditors responsible for outpatient payment integrity reviews, including outpatient facility, ambulatory surgery, emergency department, observation, and professional claim audits. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in CPT, HCPCS, NCCI edits, CMS outpatient reimbursement methodologies, and payer-specific billing requirements.
Advanced Practice Clinician (Bilingual Chinese required) VNS HealthAdvanced Practice Clinician (Bilingual Chinese required)Brooklyn, New York$109,900–$146,500 / yearFull timeManages and provides comprehensive, advanced nursing care, including post-discharge aftercare visits, annual comprehensive assessment visits, palliative care-care management program onboarding, and change in condition assessment visits (including physical examination, comprehensive history, screening for physical and/or psychological conditions, and point of care testing). Provides care in one or more care settings based on the clinical requirements: virtually, telephonically or travels to patients’ homes and/or other facilities with varying environments (e.g., elevated buildings, walk-ups, care facilities, single/multiple family homes, presence of pets, etc.) using approved transportation options.
Per Diem, Advanced Practice Clinician VNS HealthPer Diem, Advanced Practice ClinicianNew York, NY$58.30–$77.72 / hourLicenses and Certifications: License and current registration to practice as a Registered Professional Nurse in New York State required Certificate (license) and current registration to practice as a Nurse Practitioner in the State of New York, with a specialty in adult health, family health or gerontology required Valid driver's license, as determined by operational/regional needs may be required Maintains credentialed status with VNS Health Medical Care at Home and associated managed care plans required Maintains NPI, Medicaid and Medicare provider numbers preferred Maintains a collaborative practice agreement with a physician in compliance with New York State regulations preferred Must be certified by ANCC or another accrediting Nurse Practitioner body - in order to bill Medicare and meet credentialing requirements required For Psychiatric Nurse Practitioners only: Current PMHNP-BC certification required. Work Experience: Minimum of two years of experience as a nurse practitioner utilizing full scope of practice preferred Clinical home care experience or two years managerial experience preferred Demonstrated knowledge of Hedis and QARR quality measures, ICD-10 and CPT coding for reimbursement of services required Bilingual skills, as determined by operational needs required For Psychiatric Nurse Practitioners only: Minimum of two years of experience as a psychiatric nurse practitioner utilizing full scope of practice required.
Principal, Medical Economics Evergreen Nephrology LLCPrincipal, Medical EconomicsNY$135,000–$150,000 / yearThis role will help ensure the integrity of claims data flowing into enterprise datasets, enable more sophisticated economic and impact modeling, and connect cost insights with clinical and risk stratification efforts to support value-based care performance. Partner with data, actuarial, and analytics teams to validate healthcare claims data structures, ensure data is accurately represented in enterprise datasets, and resolve discrepancies affecting downstream reporting and analysis.
Senior Analyst, Payment Integrity Disputes Oscar Health IncSenior Analyst, Payment Integrity DisputesNew York, NYRemote$64,832–$85,092 / yearYou will leverage a deep understanding of Oscar''s claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement. Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah.
Senior Analyst, Payment Integrity Oscar Health IncSenior Analyst, Payment IntegrityNew York, NYRemote$64,832–$85,092 / yearThis is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah.
NewMedical Director Scientific Affairs Oscar HealthMedical Director Scientific AffairsNew York, NYRemote$237,719–$312,006 / yearThe Medical Director, Scientific Affairs provides strategic leadership to the Clinical Policy team, ensuring medical and pharmacy policies are rigorously evidence-based and aligned with current clinical advancements. Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories.
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.
Orthotist EnovisOrthotistUSA, NJIncludes American Board for Certification (ABC) Certified Orthotist (CO), Certified Prosthetist Orthotist (CPO), Board of Certification (BOC) Certified Orthotist (BOCO), National Board Certification for Occupational Therapy (NBCOT) Registered Occupational Therapist (OTR), or Federation of State Boards of Physical Therapy (FSBPT) Licensed Physical Therapist. This is an incredible opportunity to work in a fast-moving, patient-focused setting amongst extraordinarily talented professionals dedicated to making life-changing innovation possible in orthopedics and beyond with brands such as DonJoy, Aircast, ProCare and Exos.
Director, Patient Access & Revenue Cycle RWJ Barnabas Health Medical IncDirector, Patient Access & Revenue CycleNewark, NJ$133,924–$189,167 / yearAchieve goal of reducing bill hold days below target by leading revenue cycle committee meetings with members of finance, clinical departments, coding, and revenue integrity. Job Overview: The Director of Patient Access and Revenue Cycle Services is responsible for the comprehensive leadership, management, and strategic direction of all hospital patient access/revenue cycle operations.
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.
Clinical Documentation Integrity Specialist - Remote Med-Metrix, LLCClinical Documentation Integrity Specialist - RemoteParsippany-Troy Hills, NJRemoteThe Clinical Documentation Integrity Specialist performs concurrent chart reviews to validate that the clinical documentation in the medical record appropriately describes the patient's severity of illness, complexity of care, and risk of mortality to facilitate appropriate coding. Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
ProFee Audit Specialist- PRN Datavant LLCProFee Audit Specialist- PRNNYRemote$35–$45 / hourWhat We're Looking For: As a Profee Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.
Outpatient Audit Specialist PRN - Remote Datavant LLCOutpatient Audit Specialist PRN - RemoteNYRemote$35–$45 / hourWhat We're Looking For: As an Outpatient Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.
Facility-Fee Emergency Department Medical Coder Sutherland GlobalFacility-Fee Emergency Department Medical CoderClifton, NJThe Facility-Fee Emergency Department Medical Coder is responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters. The coder will review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits.
Quality Analyst - Clinical Validation Audit ExlService Holdings IncQuality Analyst - Clinical Validation AuditNYRemote$85,000–$100,000 / yearResponsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
DRG Clinical Validation Nurse MedReviewDRG Clinical Validation NurseManhattan, NY$85,000–$95,000 / yearSolid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments. Here is what we are searching for: Responsibilities: Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record.
Medical Records Coder II, Full Time, Family Medicine, Summit Atlantic Health System IncMedical Records Coder II, Full Time, Family Medicine, SummitSummit, NJAtlantic Medical Group is a physician-led and physician-governed organization that delivers the highest quality health care, at the right place, the right price, and the right time. We are a multispecialty physician group with more than 1,000 doctors, nurse practitioners and physician assistants at over 300 locations throughout northern and central New Jersey and northeast Pennsylvania.
Senior Consultant, Revenue Cycle And Financial Operations | Healthcare Business Transformation FTI Consulting, Inc.Senior Consultant, Revenue Cycle And Financial Operations | Healthcare Business TransformationNew York, NYThe Senior Consultant in Revenue Cycle and Financial Operations within our Healthcare Business Transformation practice plays a key leadership role advising physician groups, health systems, private equity and technology companies on strategies to optimize financial performance and operating effectiveness across the revenue cycle. This role supports complex client engagements from assessment through implementation, partners directly with client executives to align initiatives to enterprise priorities, and delivers measurable outcomes related to cost optimization, revenue enhancement, technology implementation and financial operations.