Medical Claims Auditor Clover Health Investments CorpMedical Claims AuditorNYRemote$90,000–$100,000 / yearAs a Medical Claims Auditor within our Special Investigations Unit, you will play a critical role in ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. Success in this role looks like: By the end of your initial 90 day period, you will have demonstrated a strong understanding of our review process and are able to effectively navigate through the various Clover systems.
ProFee Audit Specialist- FT DatavantProFee Audit Specialist- FTNew York, NYRemote$35–$45 / hourAs 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. The estimated base pay range per hour for this role is: $35—$45 USD To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc.
Director, Clinical Data Management PTC TherapeuticsDirector, Clinical Data ManagementWarren, NJ$200,700–$252,600 / yearThe Director, Clinical Data Management provides strategic and operational leadership and oversight of data management activities to ensure the quality, integrity, consistency and inspection readiness of clinical databases for subsequent analysis, reporting and regulatory submissions. Participate in cross functional team meetings, as requested, and communicate with all departments regarding project statuses/issues, provide ongoing feedback on data management workflows to increase efficiency and provide feedback to CRAs.
Supervisor of Fleet Maintenance Interstate Waste ServicesSupervisor of Fleet MaintenanceSloatsburg, New YorkOverview: Interstate Waste Services is the most progressive and innovative provider of solid waste and recycling services in the greater New York, New Jersey and Connecticut markets with a rail-served landfill in Ohio. This role is responsible for work planning and scheduling, technician supervision, repair quality control, PM program execution, parts and cost discipline, and maintenance documentation integrity.
Mgr, Payer Access & Reimbursement Quest Diagnostics IncMgr, Payer Access & ReimbursementSecaucus, NJ$125,000–$155,000 / yearAssist in the execution of MA strategies aligned with business needs and the evolving external health system environment (private and government payers, regulatory environment) for optimal utilization and reimbursement of Quest products with emphasis on oncology, particularly MRD.Identify and harness opportunities to improve coverage and reimbursement (C/R) for assigned Payer Access category in all phases (e.g., idea to market, lifecycle management). Job DescriptionThe Manager supports Payer Access & Reimbursement (PAR) activities as a member of a cross-functional team, oriented to Medical Affairs (MA) activities related to medical access, evidence generation, value proposition creation, and coverage in policy, all of which impact the reimbursement of Quest's portfolio of tests.
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.
Engagement Manager, Revenue Cycle Chartis Group LLCEngagement Manager, Revenue CycleNYRemote$137,000–$180,000 / yearEngagement Managers lead work across a portfolio of client engagements, structuring workplans, managing teams, and partnering directly with client stakeholders to turn insights into practical, sustainable improvements across the revenue cycle. The salary range for this role takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to, skills, experience, training, licensure and certifications, practice area, and other business and organizational needs.
NewQA Engineer Rectangle HealthQA EngineerWhite Plains, New York$90,000–$115,000 / yearRectangle Health, a leading financial technology company, empowers medical, dental and specialty practices with seamless and secure technology to drive revenue by increasing patient payments and streamlining practice management and payment processing. Beyond technical ability, we’re looking for someone who takes ownership, works proactively across teams, and follows through reliably once ramped up on their product area.
Senior Developer I - Full Stack C# Developer (Private Wealth Technology) Neuberger BermanSenior Developer I - Full Stack C# Developer (Private Wealth Technology)New York, NY$110,000–$150,000 / yearAn employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, seniority, geographic location, business sector, performance, shift, travel requirements, sales or revenue-based metrics, market benchmarking data, any collective bargaining agreements, and business or organizational needs. As part of the Private Wealth Front Office Technology team, you will play a key role in supporting Neuberger's Private Wealth business, focusing on enhancing the advisor and portfolio manager experience through cutting-edge technology.
AIT AI Developer Senior Associate PwCAIT AI Developer Senior AssociateNew York, NY$72,000–$184,440 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . As an AIT AI Developer Senior Associate, you will be at the forefront of software and product innovation, focusing on developing software solutions that drive digital transformation and enhance business performance.
Full-Stack Cloud Engineer PwCFull-Stack Cloud EngineerNew York, NY$77,000–$202,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . As a Full-Stack Cloud Engineer, you will be at the forefront of software and product innovation, developing transformative software solutions that drive digital transformation and enhance business performance.
Forward Deployed Software Engineering - Senior Manager PwCForward Deployed Software Engineering - Senior ManagerNew York, NY$124,000–$335,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . Your ability to direct teams through complexity, demonstrate composure in challenging situations, and initiate open coaching conversations will be key to resolving issues and enhancing team effectiveness.
Forward Deployed Software Engineering - Experienced Associate PwCForward Deployed Software Engineering - Experienced AssociateNew York, NY$63,000–$153,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . You will be exposed to clients to learn how to build meaningful connections, manage and inspire others, and grow your personal brand by deepening your technical knowledge of firm services and technology resources.
Forward Deployed Data Engineering - Senior Manager PwCForward Deployed Data Engineering - Senior ManagerNew York, NY$124,000–$335,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . Your role will involve directing teams through complexity, demonstrating composure in challenging situations, and initiating open and honest coaching conversations at all levels.
Engineering Manager- Technical Program Manager PwCEngineering Manager- Technical Program ManagerFlorham Park, NJ$114,000–$132,000 / yearAt least a Bachelor's degree or, in lieu of a degree, demonstrating in addition to the minimum years of experience required for the role, three years of specialized training and/or progressively responsible work experience in Engineering Program Management for each missing year of college is required. Guide teams in the application of Acceptance Test Driven Development (ATDD), Continuous Integration/Continuous Delivery (CI/CD), and application development frameworks to enhance quality, speed, and functionality.
Forward Deployed Software Engineering - Senior Associate PwCForward Deployed Software Engineering - Senior AssociateNew York, NY$77,000–$214,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . Within our Tax practice, you will leverage your technical skills and creative thinking to design, code, and test applications that revolutionize industries and deliver exceptional user experiences.
Cyber Defense & Engineering - Cloud Security Senior Associate PwCCyber Defense & Engineering - Cloud Security Senior AssociateNew York, NY$77,000–$202,000 / yearYour work will involve having a deep technical knowledge of cloud security and you will work with one or more Cloud Service Providers (CSP) to implement security protocols, monitor for potential security breaches, conduct risk assessments and vulnerability testing of cloud-based systems, and stay up to date with the latest security threats and trends in cloud technology. PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy .
Senior Forward Deployed Engineer Planet Labs PBCSenior Forward Deployed EngineerNYRemote$172,200–$215,200 / yearPlanet is a global company with employees working remotely world wide and joining us from offices in San Francisco, Washington DC, Germany, Austria, Slovenia, and The Netherlands. This constellation delivers an unprecedented dataset of empirical information via a revolutionary cloud-based platform to authoritative figures in commercial, environmental, and humanitarian sectors.
Staff Test Software Developer ZT SystemsStaff Test Software DeveloperSecaucus, NJ$105,000–$140,000 / yearThis includes creating test plans, test cases, and test scripts to assess the functionality and performance of hardware components or devices such as motherboard, memory, CPU, storage (SSD, HDD, NVMe) and PCIE devices (NIC, GPU, Mezz cards, RAID cards). Please be aware that certain positions may require the applicant to either 1) be a (i) U.S. citizen or national, (ii) U.S. lawful, permanent resident (aka green card holder), (iii) Refugee under 8 U.S.C. § 1157, or (iv) Asylee under 8 U.S.C. § 1158, or 2) be eligible to obtain an export control license or license exception from the Bureau of Industry and Science & U.S. Department of Commerce.
IT Engineer Principal II -Data & Analytics Public Service Enterprise Group IncIT Engineer Principal II -Data & AnalyticsNewark, NJ$121,200–$199,200 / yearIf applicable, the successful applicant must prove they are: (1) a citizen or national of the USA; OR (2) a lawful permanent resident of the United States (Non-Conditional Permanent I-551 / Green Card / Permanent Resident Card holder); OR (3) a citizen, national, or permanent resident of a "Generally Authorized" destination on the attached list not also a citizen, national, permanent resident of any country not listed; OR (4) a "Protected Individual" under the Immigration and Naturalization Act (8 U.S.C 1324b(a)(3)). The role focuses on designing, building, optimizing, and supporting data pipelines, curated datasets, and related data engineering components that serve analysts, data scientists, and business users across the company.
Lead AI Engineer The Guardian Life Insurance Company of AmericaLead AI EngineerNew York, NY$118,980–$195,465 / yearThis preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian's jobs website (Careers at Guardian at https://www.guardianlife.com/careers If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to MyHR@glic.com, making sure to provide your name and job requisition identification number.
Senior Software Engineer Coalition IncSenior Software EngineerNYIn this role, you will design, build, and operate large-scale cloud services that run internet-wide and customer-specific scans, ingest and normalize third-party threat intelligence, and surface high-quality findings into our underwriting, risk, and security workflows. Hands-on experience building or maintaining scanning, detection, or similar engine-like systems (e.g., vulnerability scanning, security scanning, data processing pipelines, or similar high-throughput engines).
Coding Compliance Coordinator (Rehab) Columbia UniversityCoding Compliance Coordinator (Rehab)Fort Lee, NJ$67,300–$75,000 / yearMaintains a thorough working knowledge of all aspects of billing and collections including billing rules and regulations, collection practices, electronic billing processes, CMS 1500 Form requirements, diagnosis and procedure coding, and applicable county, state, and federal requirements. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training.
e-FI Development Lead (FICC eTrading Technology) Canadian Imperial Bank of Commercee-FI Development Lead (FICC eTrading Technology)New York, NY$200,000–$290,000 / yearCode Quality & Review: Drive a culture of code excellence through regular code reviews, automated testing, and continuous integration, ensuring maintainability and reliability, Innovation & Continuous Improvement: Identify and implement opportunities to improve system performance, reliability, and scalability. This role combines deep technical expertise in Java with a solid understanding of Fixed Income markets to deliver reliable, scalable, and low-latency solutions that support the bank's trading and risk management objectives.
Billing and Coding Assistant Columbia UniversityBilling and Coding AssistantNew York, NY$68,000–$73,000 / yearReporting to the Coding Manager, this role is responsible for independently reviewing complex clinical documentation, interpreting coding and payer regulations, and ensuring accurate and compliant charge capture across multiple service lines. Independently review and interpret clinical documentation to ensure accurate, compliant, and complete charge capture across pain medicine and related specialties.
Full Stack AWS Cloud Developer Sunrise Systems IncFull Stack AWS Cloud DeveloperNewark, NJ$74–$84 / hourSkill Matrix: Skill Required / Desired Amount of Experience Must have Front-end design and implement user interfaces using HTML, CSS, and JavaScript Required 7 Years Must have Back-end experience with SQL and NoSQL databases, webservices, and other server-side and serverless resources Required 7 Years Design and develop full-stack applications using modern frameworks (e.g., React,Angular, Node.js, Python, NET, JavaScript) Required 7 Years Must have Hands-on experience with AWS services including Lambda, EC2, S3, IAM, and DynamoDB Required 7 Years Knowledge of authentication/authorization patterns (OAuth2, Cognito, JWT) Required 4 Years. They must be able to work across the stack-from intuitive front-end interfaces to robust back-end services-leveraging AWS platform to deliver secure, high-performance solutions.
NewMedical Billing Specialist Gottlieb and GreenspanMedical Billing SpecialistFair Lawn, NJ$60,000–$65,000 / yearWe are Gottlieb & Greenspan — a growing boutique law firm in Bergen County with a collaborative team and a workplace grounded in our core values: we are ethical, respectful of all people, accountable, positive and fun, driven, and committed to excellence . As a Medical Invoicing Specialist, you will play a key role in managing the firm's receivables: tracking outstanding balances, coordinating with healthcare providers and payers, and helping ensure accurate, timely billing.
Oracle Cloud Technical Consultant Sunrise Systems IncOracle Cloud Technical ConsultantNewark, NJ$81–$88 / hourThe consultant will play a critical role in designing, developing, and deploying Oracle Cloud SaaS solutions, Integrating, and extending these solutions using Oracle Platform as a Service (PaaS) offerings such as Oracle Integration Cloud (OIC). Skill Matrix: Skill Required / Desired Amount of Experience Oracle Integration Cloud Required 5 Years Building OTBI (Oracle Transactional Business Intelligence) and BIP (Business Intelligence Publisher) reports.
Accounts Payable And Receiveable Clerk St. John's Episcopal HospitalAccounts Payable And Receiveable ClerkGarden City, NY$27.96–$29.37 / hourAdditionally, St. John's is proud to be redesignated as a Baby-Friendly Hospital by Baby-Friendly USA - the accrediting body and national authority for the Baby-Friendly Hospital Initiative (BFHI) in the United States. The hospital is a recipient of the Gold-Plus Get with the Guidelines-Stroke Quality Achievement Award and the Gold-Plus Get with the Guidelines-Heart Failure Quality Achievement Award from the American Heart Association.
Accounts Payable and Receiveable Clerk Episcopal Health ServicesAccounts Payable and Receiveable ClerkGarden City, New YorkAdditionally, St. John's is proud to be redesignated as a Baby-Friendly® Hospital by Baby-Friendly USA – the accrediting body and national authority for the Baby-Friendly Hospital Initiative (BFHI) in the United States. The hospital is a recipient of the Gold-Plus Get with the Guidelines®-Stroke Quality Achievement Award and the Gold-Plus Get with the Guidelines®-Heart Failure Quality Achievement Award from the American Heart Association.
IT and Computing: Hardware, Software, Coding- Workforce Development Instructor (Pooled Position) County College of Morris FoundationIT and Computing: Hardware, Software, Coding- Workforce Development Instructor (Pooled Position)Randolph, NJJob Summary Instruction in non-credit continuing professional education courses in one or more of the following areas: IT certifications - A Net Security, Cisco CCNA, AWS coding, programming, and related subject areas. Posting Number: F200P Number of Vacancies: 6 Posting Date: Full Consideration Date: Closing Date: Open Until Filled: Yes Quick Link for Posting: https://jobs.ccm.edu/postings/1964 .
Medical HOME HEALTHCARE Billing Specialist / Office duty Personnel Kind Loyal Service RN Healthcare Services PLLCMedical HOME HEALTHCARE Billing Specialist / Office duty PersonnelNew Rochelle, NYFull timeCompensation is determined based on factors such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity. This role is responsible for managing billing, collections, and third-party reimbursement processes while ensuring accuracy and compliance, and is NOT limited to regular office staff duties.
AI Code Engineering Lead MadhiveAI Code Engineering LeadNew York, New YorkMadhive’s platform provides the unique ability to reach local audiences at national scale, with premium supply partnerships and end-to-end tools for planning, targeting, and measuring full-funnel campaign outcomes. Whether it’s taking ideas from previous lives and applying them in different ways or creating something completely new, we are all trail-blazing team players who think big and want to make an impact.
Oracle ERP Cloud Consultant Sunrise Systems IncOracle ERP Cloud ConsultantNewark, NJ$80–$85 / hourThe consultant will play a critical role in designing, developing, and deploying Oracle Cloud SaaS solutions, Integrating, and extending these solutions using Oracle Platform as a Service (PaaS) offerings such as Oracle Integration Cloud (OIC). Skills: Skill Required / Desired Amount of Experience Oracle Integration Cloud Required 5 Years Building OTBI (Oracle Transactional Business Intelligence) and BIP (Business Intelligence Publisher) reports.
ACO Risk Coding Specialist (Hybrid) Essen Medical AssociatesACO Risk Coding Specialist (Hybrid)Bronx, New YorkFull timeQualifications: Qualifications : - Strong working knowledge of CMS‑HCC risk adjustment model (required for accurate coding and compliance) - Solid understanding of ICD‑10‑CM coding guidelines - Ability to accurately identify and code chronic conditions requiring annual recapture - Experience reviewing face‑to‑face encounters and validating provider documentation - Skilled in retrospective and/or prospective chart reviews - Experience with provider education or documentation improvement initiatives Knowledge, Skills, & Abilities : - Deep understanding of chronic disease processes (e.g., CHF, CKD, COPD, diabetes with complications) - Familiarity with hierarchical logic and exclusion rules in HCC coding - Strong analytical, organizational, and problem‑solving skills, especially in Excel - Ability to research and resolve coding discrepancies independently - Effective written and verbal communication with clinical and non‑clinical staff - Team-based orientation with ability to manage and report out KPIs - Cultural sensitivity and ability to work with diverse team members, both US-based and offshore, and with medical providers - Consistent ability to meet productivity and quality benchmarks Education : - High School Diploma or equivalent (required) - International Medical Graduate (preferred) - Certified Risk Adjustment Coder (CRC) - Certified Professional Coder (CPC) or CCS / RHIT / RHIA (AAPC or AHIMA) Compensation & Benefits. They will become experts in HCC-based risk adjustment (prior experience preferred, but not necessary), they will conduct medical chart reviews to identify suspect conditions, and they will design and manage workflows to ensure that providers are made aware of suspect conditions, so that they can evaluate the patient thoroughly and correctly document the patient’s risk factors.
Senior Software Engineer D.A. Davidson & Co.Senior Software EngineerNY$95,000–$110,000 / yearDuties: Lead the development and support of business-critical applications, focusing on scalable architecture and maintainable codebases using ReactJS for dynamic user interfaces and NodeJS for robust server-side logic. Summary/Function: Lead and execute complex software development initiatives with a strong emphasis on front-end and back-end engineering using ReactJS, NodeJS and TypeScript frameworks.
Medical Billing Associate NJ PEDIATRIC NEUROSCIENCE INSTITUTEMedical Billing AssociateMorristown, NJ$21–$28 / hourFull timeMaintains current knowledge of, and complies with established policies and procedures including patient confidentiality/patient rights, government, insurance and third-party payer regulations. NJPNI Billers and Coding/ Collection Staff members are expected to maintain all licenses and credentials required by state and federal law.
Sr. Strategic Program Manager Carrot Fertility IncSr. Strategic Program ManagerNY$145,000–$160,000 / yearIf you''re energized by building new programs, collaborating across teams, using data to inform decisions, and translating complex healthcare reimbursement into scalable solutions, this is an opportunity to make a meaningful impact in one of healthcare''s fastest-growing benefit categories. This highly cross-functional role sits within Global Clinical Operations and serves as the operational leader for Carrot Rx while helping drive the evolution of claims-based billing capabilities that enable Carrot''s continued growth with health plans, employers, and provider partners.
NewAdvanced Practice Clinician, Per Diem (Bilingual Cantonese/Mandarin preferred) VNS HealthAdvanced Practice Clinician, Per Diem (Bilingual Cantonese/Mandarin preferred)New York, NY$58.30–$77.72Manages 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). Urgent interventions (i.e., escalations for the Care Teams, RPM, and the 24/7 Line), pharmacological and non-pharmacological interventions, ordering treatments and DME, preventative health maintenance activities, care management, referrals, discharge planning, counseling, and patient education.
NewAdvanced Practice Clinician (Bilingual Chinese required) VNS HealthAdvanced Practice Clinician (Bilingual Chinese required)Brooklyn, NY$109,900–$146,500Manages 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.
NewFull Stack Developer AxelonFull Stack DeveloperJersey City, NJ$81–$85 / hour6-8 years of expertise in application design and development using technologies and frameworks such as Spring, Spring Boot, Java, Hibernate. Partner with multiple management teams to ensure appropriate integration of functions to meet goals and identify system enhancements for new products and process improvements.
NewHealth and Information Management/Patient Registrar AxelonHealth and Information Management/Patient RegistrarNew York, NY$18–$25 / hourPre-register patients in the hospital's online system and obtain hospital medical record numbers when necessary. Proficiency in telephone, computer, keyboard, effective communication, and customer service skills (Required).
Inpatient Coder – HIM Coding – Full Time NYPInpatient Coder – HIM Coding – Full TimeNew York, NY$54.35–$62.35 / hourIn collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University College of Physicians & Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, ground-breaking research and innovative, patient-centered clinical care. NewYork-Presbyterian is one of the nation’s most comprehensive academic health care delivery systems, dedicated to providing the highest quality, most compassionate care to patients in the New York metropolitan area and throughout the globe.
Inpatient Coder - HIM Coding - Full Time NewYork-PresbyterianInpatient Coder - HIM Coding - Full TimeNew York, NY$54.35–$62.35 / hourIn collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University College of Physicians & Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, ground-breaking research and innovative, patient-centered clinical care. NewYork-Presbyterian is one of the nation's most comprehensive academic health care delivery systems, dedicated to providing the highest quality, most compassionate care to patients in the New York metropolitan area and throughout the globe.
Medical Billing and Coding Associate DocGo IncMedical Billing and Coding AssociateNY$20–$24 / hourResponsibilities: • Partners with Operations to resolve issues surrounding unbilled claims, authorizations, Physician Certification Statements (PCSs), Patient Care Reports (PCRs), and insurance, and demographic capture issues • Responsible for escalating concerns regarding questionable paperwork to appropriate management • Contact payers to verify claim status via phone or web and follow up on unpaid claims • Process appeals on aged insurance claims/denials • Analyze, identify and resolve issues which may cause payer payment delays • Identify and resolve claim edits through understanding of billing guidelines and payer requirements • Reconcile commercial and government accounts, ensuring CPT and diagnostic codes are accurate • Interpret terms for Managed Care, Commercial, Medicare, Medicaid and Workers Compensation and No Fault when applicable • Review all EOBs for correct payment, deductible, adjustments, and denials • Determining the status of claims with the insurance company, if the claim meets contractual agreements or needs adjustment • Reconcile account balances, and verify payments are applied correctly • Maintain well aged accounts, promptly resolve, and resubmit denied unpaid claims in a timely and efficient manner • Follow up on appeals/corrected submitted claims • Review and correct billing errors, which require a strong knowledge of CPT and ICD-10 coding • Review and audit customer service account inquiries • Receive inbound/outbound customer service call • Provide excellent customer service to all patients, Insurances & Facilities • Review and correct all rejections in clearing house • Perform all other related duties as assigned. Qualifications: Must have 2-3 years of medical billing experience (required) Ambulance billing experience (preferred) Extensive Medicare and Medicaid experience and understanding medical necessity in ambulance transportation Proficient in CPT and ICD-10 coding Ambulance/Medical billing certification or diploma preferred Certified Ambulance Coder (CAC) or Certified Professional Coder (CPC) preferred Excellent organizational skills and the ability to multitask in a fast-paced environment Analytical - collects and researches data; uses intuition and experience to complement data.
Billing & Coding Specialist-BI-FT Days Mount Sinai Health SystemBilling & Coding Specialist-BI-FT DaysNew York, NY$58,661–$81,675 / yearWe are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. 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.
NewMedical Analyst - (Professional Coding) - Central Billing Office NewYork-PresbyterianMedical Analyst - (Professional Coding) - Central Billing OfficeNew York, NY$47.50–$53.35 / hourUtilize your outstanding analytical skills and keen attention to detail to take on this important role, responsible for performing varied and complex diagnostic and procedural coding for patient records and optimizing of DRG assignment. And as we look to the promising future ahead, we seek talented professionals like you to help drive our financial growth while building on our reputation for excellence as one of the nation's top-ranked hospitals.
Director, Claim Payment Accuracy Clover Health Investments CorpDirector, Claim Payment AccuracyNYRemote$150,000–$195,000 / yearYou will be actively leveraging AI tools like Claude, Gemini, and ChatGPT to build out ongoing monitoring and oversight trends that identify high-impact risks to support judgmental sampling and targeted audits. By championing automated monitoring and data-driven research, you will evolve the team into a proactive strategic powerhouse, ensuring Clover''s payment ecosystem achieves top-tier precision and technological sophistication.
Manager of DRG Coding & Clinical Validation Audit Elevance Health IncManager of DRG Coding & Clinical Validation AuditLake Success, NY$115,020–$207,216 / yearPreferred Skills, Capabilities and Experiences: Preferred experience includes a minimum of 5-7 years of inpatient coding or DRG auditing experience, including 2-3 years in a leadership or supervisory capacity. The Managers of DRG Coding & Clinical Validation leads a high-performing team responsible for auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis-Related Group (DRG) assignments.
NewMDS Assessor Amsterdam Nursing HomeMDS AssessorNew York, NY$110,000–$115,000The essence of Amsterdam includes a unique combination of old-world charm, comfortable surroundings, and a state-of-the-art clinical care. Amsterdam Nursing Home is actively seeking an MDS Assessor or our Skilled Nursing Facility located in the heart of New York City.