Sr. Call Center Service Assoc Horizon Healthcare ServicesSr. Call Center Service AssocHopewell, New Jersey52,787 - $70,172 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. Receive escalated customer inquiries and provide second level resolution by initiating or continuing investigation process, utilizing available resources and accurately documenting customer inquiry and actions taken in accordance with departmental quality guidelines.
Senior Manager, Field Reimbursement PhilipsSenior Manager, Field ReimbursementNY$133,000–$212,000 / yearYour skills include demonstrated outstanding knowledge and strong understanding of US healthcare coding and billing systems, Medicare and commercial payers, hospital infrastructure, reimbursement policies and processes, and possesses expertise in data analysis, health economic evidence, and documentation. The Senior Manager, Field Reimbursement leads customer education and engagement on coding, coverage, payment, and payer policy for Philips Image Guided Therapy Device products, helping reduce reimbursement and economic barriers for U.S. patients and providers.
Training Manager ExlService Holdings IncTraining ManagerNYRemote$100,000–$120,000 / yearEXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. The ideal candidate will bring strong people leadership capability, a proven ability to develop high-performing teams, and experience driving training strategy, operational execution, and learner outcomes.
Payment Operations Associate Maven Clinic coPayment Operations AssociateNY$81,000–$95,000 / yearThrough Maven Enterprise, the company partners with more than 2,300 employers and health plans to provide end-to-end women''s and family health programs spanning fertility and family building, maternity and newborn care, parenting and pediatrics, and menopause and midlife - improving clinical outcomes, reducing healthcare costs, and expanding equitable access to high-quality care at scale. Our teams primarily operate from the New York Metropolitan area, NY, and remotely via San Francisco/Bay Area, CA, Seattle, WA, Boston, MA, Chicago, IL, and Washington, D.C. For those in our New York City office, we encourage in-person collaboration by requiring team members to work onsite three days a week (Tuesday, Wednesday, Thursday).
Sr. Call Center Service Assoc Blue Cross and Blue Shield AssociationSr. Call Center Service AssocHopewell, NJ$52,787–$70,172 / yearThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. Responsibilities: Receive escalated customer inquiries and provide second level resolution by initiating or continuing investigation process, utilizing available resources and accurately documenting customer inquiry and actions taken in accordance with departmental quality guidelines.
Call Center Service Associate Blue Cross and Blue Shield AssociationCall Center Service AssociateHopewell, NJ$47,961–$63,820 / yearThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience.
Clinical Documentation Quality Improvement Specialist II-Mount Sinai Brooklyn - Full-time - Day Mount Sinai Health SystemClinical Documentation Quality Improvement Specialist II-Mount Sinai Brooklyn - Full-time - DayBrooklyn, NY$79,720–$108,709 / yearThe Clinical Documentation Quality Improvement Specialist II is responsible for improving the overall quality and completeness of clinical documentation; facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and medical records coding staff to ensure that documentation reflects complete and accurate level of service rendered to patients. We 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.
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.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)NY$46,988–$112,200 / yearThis position will routinely handle high profile or highly sensitive matters involving cases that are national in scope, as well as, complex cases involving multi-lines of business, multiple subjects, or intricate healthcare fraud schemes. Strong communication skills, both written and oral, are necessary for the development and implementation of professional presentations for internal and external stakeholders regarding healthcare fraud matters and Enterprise approach to FWA.
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.
Case Manager Research Foundation of The City University of New YorkCase ManagerBrooklyn, New YorkThese functions include legal assessment and signing of agreements where RFCUNY is named as a fiscal agent; setting up award accounts; preparing sub-awards and assisting PIs in monitoring the work of the recipients of sub-awards; supporting project directors with hiring and managing research project and sponsored program staff; supporting the purchasing and paying for goods and services with grant and program funds; managing financial aspects of projects including accounts receivable, financial reporting, invoicing, budget monitoring, and cost compliance with uniform guidance; ensuring that sponsor financial requirements are met; monitoring compliance with applicable project and financial management rules and laws; supporting the management of independent and external audits and financial reviews; and providing data, information, management expertise, and other supports to CUNY’s research and sponsored programs. RFCUNY’s services allow CUNY researchers, faculty, and staff to focus on their intellectual curiosity and scientific discoveries, on projects and programs that serve our local and global communities, proposing concrete solutions to society’s most pressing challenges.
Pharmacy Care Technician - Work From Home (Fairfield, NJ) CVS Health CorpPharmacy Care Technician - Work From Home (Fairfield, NJ)NJ$17–$31.30 / hourPharmacy Care Technicians assist with inbound phone calls; interact with customers and cross functional team to answer questions, solve problems, provide education, and maintain our company's reputation for high-quality service. In this role, you will assist in accurately reading, interpreting and entering prescriptions into the computer system including calculation of doses and assignment of directions and accepting proper insurance payment in a timely fashion.
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.
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 InvestigatorNJ$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.