The Appeals Analyst investigates denied healthcare claims by reviewing clinical policies, contracts, and supporting documentation to facilitate reimbursement. They also build relationships with payers and providers while documenting all actions taken within the claims recovery system.
Conduct clinical reviews to assess medical necessity, level of care, documentation, and coding or reimbursement support, while following payer, managed care, and CMS requirements. Support denial management and appeals, communicate findings to clients and payers, research applicable policies and regulations, and use technology, including AI-enabled tools, to improve case review workflows.
The Senior Cloud Security Engineer will lead the design and implementation of secure cloud architectures and guardrails within AWS. They will also secure AI/ML and Generative AI systems while ensuring compliance with healthcare regulations like HIPAA and HITRUST.
Manage the full sales cycle across an assigned Atlantic Northeast territory of 40–50 large hospitals and health systems, from prospecting and qualification through proposals, negotiation, and closing new business. Coordinate internal resources, maintain accurate CRM and pipeline records and forecasts, meet sales targets, and monitor market and competitive developments.
The Integration Engineer II supports the development, implementation, and configuration of interface solutions across internal and external platforms. They are responsible for troubleshooting interface issues, maintaining architectural documentation, and managing information flow between customers.
The employee will contribute to various projects and tasks based on departmental needs while collaborating with team members to achieve company goals. They are expected to demonstrate flexibility in taking on different roles and adhere to company policies and procedures.
