Medical Coding Specialist Capital Rx, Inc.Medical Coding SpecialistNew York, NY$70,000–$85,000 / 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. This role offers the opportunity to play a key part in ensuring accurate claims processing, supporting client implementations, and helping drive innovation within a growing healthcare technology organization.
Billing Specialist Community OptionsBilling SpecialistPrinceton, New JerseyThis person will collect Medicaid reimbursements by resolving discrepancies, adjusting claims, preparing reports, monitoring collections, and providing excellent customer service to internal staff and designated payers. Community Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states.
Senior Manager Product Consulting (Facets) ApolisSenior Manager Product Consulting (Facets)Bridgewater, NJRemote$75–$95 / hourThe ideal candidate will serve as a Facets Subject Matter Expert (SME) , leading business discussions, solution design, and implementation activities for healthcare payer clients. Description: We are seeking an experienced Senior Manager Product Consulting (Facets) with 17+ years of healthcare IT experience and 5 10+ years of Facets consulting expertise .
Clinical Investigator Oscar Health IncClinical InvestigatorNew York, NYRemote$75,348–$98,894 / yearBonus points: Bachelor of Science in Nursing (BSN), Associate Degree in Nursing (ADN) with a Bachelor of Science in Health Administration, Clinical Informatics, or a related Medical Science field, or Associate Degree in Nursing (ADN) with 5+ years of specialized clinical audit experience. Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia.
Business Systems Analyst - No Surprises Act Contech SystemsBusiness Systems Analyst - No Surprises ActNewark, NJ$50–$75 / hourThis individual will work closely with business stakeholders, operations teams, and technology teams to analyze business processes, define requirements, and support enhancements to systems responsible for NSA compliance, claims processing, and reimbursement workflows. Our client is seeking an experienced Business Systems Analyst with a strong background in the U.S. healthcare payer industry to support initiatives related to the No Surprises Act (NSA).
Business Analyst With Pharmacy Benefit Management - Remote The Dignify Solutions, LLCBusiness Analyst With Pharmacy Benefit Management - RemoteEdison, NJRemoteCandidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists. Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.
Disputes Analyst Phaxis LLCDisputes AnalystNew York, NY$35–$50 / hourConduct end-to-end investigations of complex debit card disputes involving fraud, unauthorized activity, merchant disputes, processing errors, duplicate billing, service-related disputes, and scam claims. You will serve as a subject matter expert for dispute operations, support quality and process improvement initiatives, and provide guidance to junior analysts while ensuring compliance with network regulations and client requirements.
Senior Technical Trainer - (Enterprise Solutions) Capital Rx, Inc.Senior Technical Trainer - (Enterprise Solutions)New York, NY$98,400–$123,000 / yearJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and. Develop and maintain engaging and effective technical training materials and resources (including user guides, job aids, video content, eLearning modules, and SOPs) that enable users to successfully navigate and utilize the Unified Claims Processing platform.
Senior Specialist, Pharmacy Systems Operations - Remote EmblemHealth IncSenior Specialist, Pharmacy Systems Operations - RemoteNew York, NYRemote$68,040–$118,800 / yearServe as pharmacy systems coding subject matter expert for Prior Authorization with a focus on medical drug claim processing, review of utilization management, PA processing, and appeals; as well as the following: claims processes and JUDI interoperability with FACETS edits and other connection troubleshooting. Provide technical and subject matter expertise support for implementations and day to day operations of Pharmacy functions and vendor coordination.
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.
NewBenefits Coordination and Recovery Specialist EmblemHealth IncBenefits Coordination and Recovery SpecialistNew York, NY$56,160–$99,360 / yearInterface with the Benefits Coordination & Recovery Center (BCRC) and update the Common Working File (CWF) to ensure the global Medicare record accurately reflects other health insurance (OHI). Assist in the collection and validation of data required for Section 111 of the MMSEA, ensuring accurate member records are transmitted to CMS to avoid civil monetary penalties.
Configuration and Quality Audit Analyst | Hybrid NY HealthfirstConfiguration and Quality Audit Analyst | Hybrid NYNew York, NY$68,900–$99,620 / yearAt least three years of experience in a managed care organization, commercial health plan, government program, third-party administrator, or other healthcare operations environment performing claims analysis, configuration audit, provider reimbursement, payment integrity, or healthcare data analysis. Candidate must display effective communication skills and have detailed skillset to configure Office365, effectively communicate product updates, interface with the vendor on potential issues, and ensure platform governance rules are followed.
Staff Software Engineer, Performance Capital Rx, Inc.Staff Software Engineer, PerformanceNew York, NY$200,800–$251,000 / yearClaims processing, prior authorization, and supporting data products drive highly complex, data-intensive workloads where decisions across the entire database stack - including schema design, database configuration, connection management, and storage architecture - directly determine the platform's ability to deliver reliable performance under heavy read and write load. Experience evaluating and implementing cluster topology changes: connection pooling configuration, read replica strategy, partitioning/sharding approaches, and PostgreSQL - parameter tuning for high-concurrency transactional workloads .
NewAssociate, Payment Integrity IBR Oscar Health IncAssociate, Payment Integrity IBRNew York, NYRemote$82,717–$108,566 / 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. Proactively identify and document potential billing errors, including duplicate billing of items, services, or procedures as improper unbundling of services (e.g., separating components that should be billed together) and charges for non-covered or non-rendered services.
Client Success Manager (MAPS) Office AllyClient Success Manager (MAPS)Newark, NJ$65,000–$70,000 / yearWe offer a range of affordable, cloud-based revenue cycle management solutions –from eligibility verification and claims management to revenue recovery and payment processing –that help healthcare organizations of all sizes streamline operations and reduce administrative burdens so they can focus on what matters most: patient care. Together, we are expanding our capabilities across the full healthcare transaction lifecycle, connecting claims, payments, and data exchange to deliver a more seamless and efficient experience for providers, payers, and partners.
Medical Network Provider Relations Manager Capital Rx, Inc.Medical Network Provider Relations ManagerNew York, NY$126,800–$158,500 / 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. The Provider Relations Manager works closely with Network Development, Contracting, Claims, Operations, and Client Services teams to support provider engagement, optimize network performance, and drive strategic growth initiatives.
NewStaff Product Manager, Insurance HOVER IncStaff Product Manager, InsuranceNew York, NYRemote$186,000–$260,000 / yearHover has Hubs in San Francisco and New York City, where we expect that all employees living within a 50-mile radius of our offices will come into their local Hover office at least three times a week to build rapport and foster organic connection. Backed by leading investors like Google Ventures and Menlo Ventures, and trusted by industry leaders including Travelers, State Farm, and Nationwide - we're redefining how people understand and interact with their spaces.
Senior Solution Architect ModelN Moderna IncSenior Solution Architect ModelNPrinceton, NJ$142,500–$256,500 / yearTriage, investigate, and coordinate resolution of platform and process issues, including working with ModelN, system integrators, managed service providers, Boomi/integration teams, SAP/customer master teams, EDI teams, data teams, and other internal or external partners as needed. This role will serve as a senior techno-functional resource focused on the ModelN platform and the broader US Revenue Management ecosystem, with responsibility for helping ensure that business processes, platform configuration, integrations, data flows, reporting, and support activities are aligned to Moderna's operational and compliance needs.
Strategic Development Manager - Protection General Motors Financial Company, Inc.Strategic Development Manager - ProtectionNYRemote$58,000–$110,000 / yearCollaborate with the dealer''s assigned Account Manager - Protection to achieve key performance criteria, incorporating upfront expectations, meeting dealership objectives, and communicating ongoing progress, successes, challenges, and opportunities. Our sales team spans the United States working with GM dealers on a variety of initiatives to drive product sales, customer loyalty, and profitability for the dealers and the brand.
Account Manager, PBA Capital Rx, Inc.Account Manager, PBANew York, NY$100,400–$125,500 / yearAs an Account Manager focused on PBA and Medicare, you'll be at the forefront of delivering seamless client experiences by managing benefit changes, implementing new plans, and ensuring pricing accuracy-all while driving impactful solutions that directly shape business success. By 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.