Deputy Chief Operating Officer - Health Plan Metroplus Health Plan IncDeputy Chief Operating Officer - Health PlanNew York, NY$300,000–$325,000 / yearDemonstrated knowledge and experience overseeing a diverse array of managed care product lines of business, managed care claims processing and call center operations, Experience and knowledge in the use of Project Management tools to improve and expand the offerings and services provided by MetroPlusHealth, Experience and knowledge related to customer experience and service, Comprehensive understanding of the principles and practices of managing information systems and services, and a thorough understanding of how operating areas and information services work together to improve current and future results. The Deputy Chief Operating Officer (DCOO) is a member of MetroPlusHealth's Senior Management team and is vital in providing assistance with the oversight, management, and supervision of Operations, in a matrix organizational structure including: Provider Network Operations, Call Center, Credentialing, Facilities, Enrollment & Membership, Vendor Management, Customer Success, and Claims.
Senior Analyst, Kroll Settlement Administration Kroll, LLCSenior Analyst, Kroll Settlement AdministrationNew York, NY$32–$36 / hourAs a settlement administrator, we are responsible for notifying potential class members, reviewing and processing claim forms filed by individuals and entities, calculating losses, auditing claims to determine the extent of the damages incurred and processing and distributing funds to eligible class members under the court's direction. Kroll Settlement Administration, part of Kroll's Business Services division, is the leader in cutting-edge technology and consulting services for class action, mass tort, regulatory remediation and government claims administration.
Experienced Associate, Forensics BDO USA PCExperienced Associate, ForensicsNY$65,000–$85,000 / yearJob Summary: The Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. Keywords: Forensic, Healthcare Coding, Payment Integrity, Revenue Integrity, Revenue Cycle Management, Consulting, Disputes, Litigation, Investigation, Fraud, Waste, Abuse, Coding Auditor, Charge Capture, Healthcare Compliance.
Business Systems Analyst Diverse Lynx, LLCBusiness Systems AnalystFlorham Park, NJFDB Drug Nomenclature, Formulary & Preferred Drug List Design. Drug Coverage Configuration: Inclusions, Exclusions & Prior Authorization Criteria.
Sr. Forward Deployed Engineer Cohere Health Technologies LLCSr. Forward Deployed EngineerNYRemote$135,000–$155,000 / yearBacked by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
VP, Logistics & Warehousing US Remote Fictiv IncVP, Logistics & Warehousing US RemoteNYRemote$30,000–$55,000 / yearReporting directly to the Senior Vice President of Operations & Supply Chain, the Vice President of Logistics & Warehousing will serve as a senior executive responsible for the full lifecycle of inbound and outbound logistics, warehousing operations, carrier partnerships, trade compliance, import operations, and distribution network strategy across MISUMI Americas. The ideal candidate brings deep experience in logistics, warehousing, import operations, carrier management, and global supply chain execution, along with a strong ability to lead teams, manage large budgets, and drive operational excellence through data, technology, AI, and continuous improvement.
Manager of Provider Contract Configuration Metroplus Health Plan IncManager of Provider Contract ConfigurationNew York, NYRemote$130,000–$140,000 / yearThis role will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. Oversight of functions performed by delegated vendor(s) as it relates to provider pricing configuration, claims processing, with emphasis on provider pricing configuration, testing and accuracy.
EPIC Physician Billing Analyst KLM CareersEPIC Physician Billing AnalystHicksville, New York3. Do you have 3+ years of experience and expertise in Epic's Professional Billing module, including charge router, work queue configuration, collection agency workflows, statement processing, benefit engine, and estimates. Expertise in Epic's Professional Billing module, including charge router, workqueue configuration, collection agency workflows, statement processing, benefit engine, and estimates.
Analyst, Data Exchange (Medical, Dental & Vision) Capital Rx, Inc.Analyst, Data Exchange (Medical, Dental & Vision)New York, NY$96,800–$121,000 / yearPosition Responsibilities: Data Integration & Mapping: Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 - eligibility and responses, 278 - Prior Auth, 276/277 - claim status, 999/TA1 - file level acknowledgement as well as proprietary formats. Position Summary: The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx - JUDI Health and its various partners, including employers, providers, and other TPAs.
Procedural Billing Specialist II-MSW-FT Days Mount Sinai Health SystemProcedural Billing Specialist II-MSW-FT DaysNew York, NY$59,895–$89,843 / 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.
AI Forward Deployed Engineer Recruiting From ScratchAI Forward Deployed EngineerNew York, New YorkBacked by leading venture investors and founded by a team of healthcare operators and technology leaders, the company is leveraging AI to reduce costs, improve care outcomes, and eliminate inefficiencies across the healthcare ecosystem. Measure success through operational outcomes, including increased efficiency, reduced manual effort, improved scalability, and cost savings.
Valet Manager - White Plains, NY Laz Parking LtdValet Manager - White Plains, NYWhite Plains, NYResponsible for payroll processing; ensuring sign off on hours in timely manner; collaborate with the local payroll department to ensure pay data is completed properly; work with Human Resources Business Partner to ensure proper wage and hour compliance. Ensure that increased revenue, controlled expenses, and customer satisfaction are maximized by maintaining the highest level of safety & service thresholds and initiatives that are aligned with the expectations of our various clients.
NewRisk Adjustment Coding Specialist VNS HealthRisk Adjustment Coding SpecialistNew York, New York$33.88–$42.35 / hourFull timeMinimum two years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits required Additional years of experience/specialized certification/training may be considered in lieu of educational requirements required Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures required Strong knowledge of claims processing procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications required Strong planning, organizational, interpersonal, verbal and written communication skills required Must be PC literate and possess a strong understanding of Microsoft applications required Ability to handle multiple priorities and meet deadlines required Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required Ability to switch gears and independently collaborate with other departments for all ad lib projects as necessary required. Provider Engagement, Audit, Training and Support and supports supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
Clinical Account Consultant, PBM Capital Rx, Inc.Clinical Account Consultant, PBMNew York, NY$140,000–$160,000 / 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. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform.
Sr. Lead, Payer Gateway Management Capital Rx, Inc.Sr. Lead, Payer Gateway ManagementNew York, NY$174,800–$218,500 / yearPosition Responsibilities: Oversee payer gateway and clearinghouse operations supporting HIPAA EDI transactions, including 837 claims, 270/271 eligibility, 276/277 claims status, 835 remittance/payment support, acknowledgments, rejects, and related file exchanges. This role ensures accurate, timely, and compliant processing of HIPAA EDI transactions and hosted gateway solutions supporting claim submissions, eligibility verification, claims status checks, acknowledgments, rejections, file reconciliation, and production issue resolution.
Sr. Lead Provider Network Onboarding And Integration Capital Rx, Inc.Sr. Lead Provider Network Onboarding And IntegrationNew York, NY$174,800–$218,500 / 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 Senior Lead Provider Network Onboarding and Integration will play a critical role in supporting the expansion of the TPA business by leading the onboarding, integration, and operational enablement of national, regional, direct contract provider networks and network aggregators.
Manager, Analytics - Business Insights Capital Rx, Inc.Manager, Analytics - Business InsightsNew York, NY$150,800–$188,500 / 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. Track record of partnering closely with internal and external stakeholders to provide consultative analytics support, proactively advising on business opportunities.
Senior Analyst, Risk Management, Audit Capital Rx, Inc.Senior Analyst, Risk Management, AuditNew York, NY$117,600–$147,000 / yearThis is a hybrid role spanning risk management, project execution, and data analytics: the Analyst plans and coordinates cross-functional workstreams, analyzes data to surface risks and trends, and improves the processes and reporting that keep regulatory and client audits, corrective actions, performance guarantees, finance accruals, and client-experience initiatives controlled and defensible. 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.
Analyst, Client Experience & Optimization Capital Rx, Inc.Analyst, Client Experience & OptimizationNew York, NY$98,400–$123,000 / yearPosition Summary: The Senior Analyst, Client Experience & Optimization (CERO) supports the Risk Management function by independently coordinating risk-based operational initiatives from intake through execution, using judgment to develop approaches, evaluate cross-functional inputs, and escalate risks or barriers at appropriate decision points. This role identifies operational gaps and recurring risk patterns, develops and maintains process documentation and workflow maps, builds operational dashboards and KPI reporting, and supports the automation of manual processes to improve consistency, data quality, and operational efficiency across Client Services.
Senior Analyst, Risk Management, PG Capital Rx, Inc.Senior Analyst, Risk Management, PGNew York, NY$98,400–$123,000 / yearOperating within the Client Services, Account Advocacy & Risk Management team, the Analyst maintains the centralized PG database, produces performance and risk reporting, and partners cross-functionally with Legal, Finance, Analytics, and Client Services to improve data quality, clarify ownership, and mature the end-to-end PG process. Plan and execute risk-based initiatives end to end - structuring project plans, coordinating cross-functional workstreams, and tracking progress, dependencies, and action items to closure across Legal, Finance, Analytics, and Client Services partners.