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.
NewCall Center Service Associate Horizon Healthcare ServicesCall Center Service AssociateHopewell, New Jersey47,961 - $63,820 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. For over 90 years , we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.
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.
Medical Director, General Surgery - Remote UnitedHealth Group IncMedical Director, General Surgery - RemoteNew York, NYRemote$248,500–$373,000 / yearWe are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
Patient Navigator Healogics IncPatient NavigatorNorth Bergen, NJ$20.63–$25.36 / hourLearn more about this role here: Healogics is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. All Healogics employees must perform their job responsibilities according to all Healogics policies, Hospital policies, as well as to accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services (CMS) guidelines, as applicable.
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.
Radiology Scheduler Call Center UnitedHealth Group IncRadiology Scheduler Call CenterMount Kisco, NYClinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S. Performs certain follow-up services for patients in a prompt and courteous manner such as scheduling specialist appointments scheduling follow-up appointments and obtaining copies lab results or specialist reports.
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.
Patient Services Representative UnitedHealth Group IncPatient Services RepresentativeWest Nyack, NYConsider number of unauthorized or unscheduled absences a pattern of before and after-weekend absences tardiness and early departures and long meal periods in accordance with the policy Promotes a positive work attitude fostering teamwork and acceptance of management decisions Supports on-site training initiative for new Patient Services employees Assist co-workers whenever possible to achieve office goals and patient satisfaction Works independently takes initiative in completing assignments and does so without reminder Completes all miscellaneous work assigned by Director Assistant Director Manager Supervisor Team Leader or Physician accurately and in a timely manner Opens office as needed turns on copiers terminals and printers and updates computer for current days session Communicate with clinical staff to keep patient informed of appointment status Verifies insurance eligibility and coverage by phone independent website RTE or EPIC at time of service Verifies patient demographic and insurance information at time of visit. Act on notations and complete the check in process successfully Schedules Cancels Reschedules patient appointments as ordered by the physician adhering to scheduling policies and procedures Obtains HMO insurance referrals as required for maximum reimbursement of services rendered Notifies management or other departments appropriately using Clerical Templates for various issuesrequestsreasons Maintains supply inventories and equipment necessary for the effective performance of the job communicates supply needs to the office supervisor in a timely manner Maintains a neat organized orderly environment in the reception and waiting room areas including physician business cards brochures signage etc Closes office as needed ensuring all patients accounted for and discharged.
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.
NewSenior 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.
NewSenior 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.
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.
Applied AI Scientist, Clinical AI Agents R37 Lab, R1 RCMApplied AI Scientist, Clinical AI AgentsNew York, New YorkPhare Health is now part of R1 and its AI innovation engine, R37 Lab , bringing Phare’s frontier clinical reasoning technology together with one of the largest healthcare platforms in the U.S. At R37 and Phare, we are building the first AI-native Healthcare Revenue Operating System : a connected platform that reasons over full medical records, payer logic, and financial workflows to automate medical coding, billing, and follow-up. You will be embedded in hard healthcare problems — clinical documentation integrity, medical coding, denial prevention, appeals, revenue cycle workflows, and payer logic — and will own the loop from problem framing to agent design, evaluation, deployment, trace analysis, and ongoing improvement.
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.
Assistant Director (FGP), Revenue Optimization & Analytics - Radiology, Manhattan NYU Langone HealthAssistant Director (FGP), Revenue Optimization & Analytics - Radiology, ManhattanNew York, NY$121,792.22–$210,091.64Full timeWork closely with departmental and revenue cycle leadership on initiatives that target revenue optimization for radiology services, including identifying bottlenecks, analyzing root causes, and implementing corrective measures. Regularly meet with Department Chair and his leadership team to present revenue cycle insights, address payor issues, and review opportunities for improvement using practice-specific and departmental data.
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.
Data Manager Maimonides Medical CenterData ManagerBrooklyn, NY$70,000–$85,000 / yearThe system is anchored by Maimonides Medical Center, one of the nation's largest independent teaching hospitals and home to centers of excellence in numerous specialties; Maimonides Midwood Community Hospital (formerly New York Community Hospital), a 130-bed adult medical-surgical hospital; and Maimonides Children's Hospital, Brooklyn's only children's hospital and only pediatric trauma center. Prepares actionable analyses and reports to support managed care and value-based contracting, including trend analyses (volume, spend, unit cost, case mix, LOS), cost and utilization analyses, and benchmark comparisons; prepare reports using SQL server, Microsoft Access; assists in proposal development and contract renewals.