Medicaid Risk Adjustment Market Manager CVS Health CorpMedicaid Risk Adjustment Market ManagerNJ$54,300–$145,860 / yearPartner with segment product, sales, network, clinical teams to implement processes aimed at strengthening member and provider engagement of Revenue Integrity programs resulting in improved outcomes. This is a high-visibility role responsible for driving market level engagement, delivering insights, and demonstrating the value of Medicaid risk adjustment performance to senior leaders and market partners.
Manager, Compliance RWJ Barnabas Health Medical IncManager, ComplianceOceanport, NJ$110,150–$143,195 / yearDetailed knowledge of federal and state statutes, regulations, policies, procedures, and guidance that governs healthcare Compliance programs and operations, Strong understanding of healthcare Compliance programs and processes, and the ability to analyze issues, identify compliance risks and oversee timely and effective remediation, Ability to clearly articulate requirements and complex compliance issues to senior leadership and impacted business units/departments, Expertise with federal and state regulatory audit processes, and the ability to clearly and effectively communicate with auditors and regulators, Strong sense of ethics and integrity to ensure that the organization adheres to regulatory requirements and operates in a compliant manner. You have excellent written and verbal communication skills are necessary for interacting with employees, management, stakeholders, and regulatory bodies, You demonstrate leadership and management Skills: lead and motivate the Compliance team, effectively coordinate with various departments and physician practices to manage projects, and influence others on compliance integrity.
Data Analyst NYU Langone Medical CenterData AnalystNew York, NY$66,300–$79,023 / yearHoused in the Community Service Plan, Brooklyn Data Station is guided by principles of community-engaged research and works collaboratively with researchers, clinicians and community-based partners to help inform community needs and assets assessments, quality improvement initiatives, and applied research projects to improve population health. The Brooklyn Data Station at NYU Grossman School of Medicine's Department of Population Health is a resource for finding, accessing, analyzing, visualizing, and communicating clinical and community-level data, with a focus on neighborhoods in New York City and Long Island.
NewRemote | Medical Coder — $25–$40/hour 24-MagRemote | Medical Coder — $25–$40/hourNew York, New YorkRemoteWe are sharing a specialised consulting opportunity for experienced Medical Coders with strong expertise in ICD-10, CPT, Evaluation & Management coding, clinical documentation review, and coding quality assurance to contribute to an advanced AI training and medical-data evaluation project. Selected professionals will review clinical documentation, assign and validate medical codes, apply E&M guidelines, and provide structured feedback on coding quality and edge cases.
Benefit Operations Specialist Capital Rx LLCBenefit Operations SpecialistNew York, NY$95,000–$100,000 / yearBy 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. Position Summary: Join our first-of-its-kind Integrated Benefits team as a Benefit Operations Specialist, where you will play a pivotal role in delivering comprehensive medical and pharmacy benefit programs for Judi Health clients.
Clinical Quality Specialist HealthfirstClinical Quality SpecialistNew York, NY$68,900–$99,620 / yearThe Clinical Quality Specialist is responsible for performing Healthcare Effectiveness Data and Information Set (HEDIS) medical record review, supplemental data validation, data abstraction, and clinical data quality activities using internal and external clinical data sources. The specialist works collaboratively with providers, vendors, and internal departments to ensure compliance with NCQA, CMS, state, and organizational requirements while supporting data integrity and audit readiness.
Clinical Documentation Expert - Fully Remote MercorClinical Documentation Expert - Fully RemoteNew York, New YorkRemoteMonitor CDI program KPIs, including query response rates, CC/MCC capture rates, case mix index, and DRG accuracy. 5+ years of experience in clinical documentation integrity or improvement, with 2+ years in a manager or leadership role.
Decision Scientist - Clinical Informatics (Clinical Data Standards) CVS Health CorpDecision Scientist - Clinical Informatics (Clinical Data Standards)NJ$64,890–$158,620 / yearA&BC leverages advanced analytics, clinical informatics, and hypothesis-driven approaches to transform data into actionable, customer-centric insights that drive growth, improve health outcomes, and expand access to healthcare across all CVS Health businesses. Collaborate with data engineering teams to inform data pipeline development, ensuring clinical data is ingested, transformed, and stored in ways that support downstream analytics needs.
CDI Leader - Clinical Documentation MercorCDI Leader - Clinical DocumentationNew York, New YorkRemoteMonitor CDI program KPIs, including query response rates, CC/MCC capture rates, case mix index, and DRG accuracy. 5+ years of experience in clinical documentation integrity or improvement, with 2+ years in a manager or leadership role.
Surgical Coordinator - Orthopedics - Health and Wellness Center Hackensack University Medical CenterSurgical Coordinator - Orthopedics - Health and Wellness CenterClark, NJThe posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. A day in the life of a Surgical Coordinator at Hackensack Meridian Health includes: Coordinates all aspects of tests, procedures and surgeries under the direction and supervision of the Practice Supervisor or Manager and physician(s) in an efficient manner.
NewRisk Adjustment Analyst I HealthCare Partners, MSORisk Adjustment Analyst IGarden City, NY$65,000–$75,000 / yearThis position serves as a bridge between data-driven insights and operational execution, helping to identify and resolve gaps in clinical documentation, monitor data integrity, and inform strategies that enhance risk score accuracy and regulatory compliance. The Analyst will work collaboratively with both internal teams and external partners, including health plans and vendors, to execute projects, improve processes, and ensure accurate data submissions.
Billing Services Representative Saint Peter's Healthcare System IncBilling Services RepresentativePiscataway, NJReview outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances. Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.).
NewAppeals Specialist GeneDX LLCAppeals SpecialistCranbury, NJRemote$31.25–$33.65 / hourGeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world's largest, rare disease data sets. The Appeals Specialist is responsible for reviewing denied claims, identifying root causes, and submitting well-documented appeals to maximize reimbursement for specialized laboratory services.
Medical Biller FemmPro OB/GYNMedical BillerGarden City, New YorkManage and resolve Zero-Pay Worklist, Unpaid claims, Fully Worked Receivables, Review and respond to adjustments / payment data with approval (or initiate appeal) communicate trends and root issues through proper lines of reporting. • Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes.
Lead Software Engineer - AI Humana IncLead Software Engineer - AINew York, NY$129,300–$177,800 / yearExercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Clinical and Product Partnership: Collaborate closely with product managers, designers, clinicians, and data stakeholders to understand care delivery workflows and translate them into well-scoped, high-impact AI features.
NewMDS Coordinator Sunrise Senior Living ServicesMDS CoordinatorEdison, New Jersey$41–$56.65 / hourWhat You’ll Do: • Coordinate and complete MDS, CAA and Care Plans per federal and state regulations • Maintain MDS schedules and ensure timely, accurate submissions • Facilitate Triple Check and weekly Medicare meetings • Review clinical documentation for accuracy and reimbursement support • Ensure Care Plans are individualized and aligned with resident goals • Monitor Quality Indicators and analyze CASPER/iQIES reports • Participate in IDT and QAPI meetings to drive quality improvement • Provide MDS and documentation training to clinical team members • Support ICD-1 coding accuracy and skilled services documentation • Collaborate with Business Office to ensure timely billing Resident Assessment Coordinator (RN/LPN) – Lead MDS Accuracy and Drive Quality Care Outcomes MDS Coordinator | Resident Assessment Coordinator | RN | LPN | Skilled Nursing | Care Planning | RAI. The Resident Assessment Coordinator (RAC) leads the Resident Assessment Instrument (RAI) process for Skilled Nursing, ensuring accurate MDS completion, individualized care planning and regulatory compliance.
Surgical Coordinator - Orthopedics - Health and Wellness Center Hackensack Meridian HealthSurgical Coordinator - Orthopedics - Health and Wellness CenterClark, New JerseyFull timeThe posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. Responsibilities: A day in the life of a Surgical Coordinator at Hackensack Meridian Health includes: Coordinates all aspects of tests, procedures and surgeries under the direction and supervision of the Practice Supervisor or Manager and physician(s) in an efficient manner.
Wound Care Nurse - Lpn-Lvn - Full Time Project RestorixWound Care Nurse - Lpn-Lvn - Full TimeRahway, NJWhat You'll Do: Provide patient care based on scientific principles/nursing theory and evidence-based practiceImplement physician orders accurately within appropriate time framesRecognize change in the patient's condition and intervene appropriatelyPrioritize nursing actions including reflecting patient needs, acuity, and desired outcome. Qualifications: Valid LPN nursing license requiredValid CPR certification from the American Heart Association requiredPrior experience working with wound care patients preferred (Will train)Experience with billing and coding preferred.
Clinical Data Specialist Richmond Medical CenterClinical Data SpecialistStaten Island, New YorkDay Shift - 7.5 Hours (United States of America) The Clinical Data Specialist (Coder) codes hospital records for the purpose of reimbursement, research and compliance with federal regulations according to diagnosis, operations and procedures using ICD-10-CM classification system. If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Senior Post-Market Pharmacovigilance Specialist (Remote) MMSSenior Post-Market Pharmacovigilance Specialist (Remote)Jersey City, NJRemoteWith a global footprint across four continents, MMS not only maintains an industry-leading customer satisfaction rating but also fosters a collaborative and inclusive work environment where employees can thrive. We support the pharmaceutical, biotech, and medical device industries with our proven scientific approach to complex trial data and regulatory submission challenges.