Lead the delivery of sales objectives by managing direct retail relationships and a Direct Store Delivery (DSD) distribution network. Develop branded and private label business while collaborating cross-functionally to drive innovation and market expansion.
Remote Jobs & Work From Home Positions in United States (121,653)
Remote in = United States
Investigate allegations of healthcare fraud, waste, and abuse through claims audits and data mining. Prepare detailed investigative reports for referral to state and federal agencies and coordinate resolutions with health plans.
Administrative Coordinator
Center for Autism and Related Disorders
·
Full Time
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16 hours ago
Center for Autism and Related Disorders
Provide administrative and operational support for the onboarding and initial training of newly hired clinical staff. This includes coordinating logistics, maintaining trainee records, and facilitating communication between clinicians and internal departments.
Perform calculations for patient accounts receivable valuation and manage monthly settlements using the Kodiak RCA tool. Support the month-end close process by generating journal entries and analyzing net patient revenue for finance leadership.
Clinical Investigator I (Special Investigation Unit)
Centene Corporation
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Full Time
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16 hours ago
Centene Corporation
Audit medical records and claims data to identify inappropriate billing practices, abuse, and fraud. Prepare findings summaries and recommend policy changes to prevent future fraudulent activities.
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Clinical Investigator - Behavioral Health
Centene Corporation
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Full Time
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16 hours ago
Centene Corporation
Conduct comprehensive reviews of medical records and claims to identify potential fraud, waste, and abuse in behavioral health care. Collaborate with the Special Investigations Unit to analyze billing patterns and recommend preventative measures to internal policies.
Senior Pharmacy Technician - Freedom Fertility Pharmacy - AZ, MA or IL
Cigna Healthcare
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Full Time
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16 hours ago
Cigna Healthcare
Coordinate fertility plans and medications by handling inbound patient calls and accurately entering prescription and insurance data. Ensure a high-quality patient experience by resolving issues and processing claims efficiently.
Manager, Payment Integrity - Platform Management
Centene Corporation
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Full Time
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16 hours ago
Centene Corporation
Develop and manage strategic fraud, waste, and abuse activities to ensure billing integrity and compliance with state and federal requirements. Lead teams of analysts in investigating referrals and preparing saving reports for stakeholders.
Lead the design and execution of clinical programs focused on quality metrics and Stars improvement within a value-based care model. Oversee cross-functional projects, manage stakeholder relationships, and translate complex data into actionable strategic recommendations for senior leadership.
Act as a subject matter expert to guide prospects through complex sales cycles by delivering technical expertise and tailored solution recommendations. Collaborate with sales, product, and engineering teams to translate customer needs into measurable business value and technical specifications.
Facilitate the transition of patients from hospital settings to outpatient dialysis care through education and referral processing. Build and maintain relationships with hospitals, physicians, and kidney care providers to ensure seamless patient placement.
The Title Express Processor assists insurance companies with the procurement of vehicle titles and paperwork while coordinating with financial institutions and owners. Responsibilities include managing call queues, creating total loss packets, and ensuring document compliance per state guidelines.
The AI Intern will support the development, testing, and improvement of AI and machine learning models. Responsibilities include data preparation, conducting research on AI trends, and building prototypes or automation workflows.
The Analyst supports Integrated Kidney Care initiatives by managing care gaps and monitoring clinical performance to improve quality metrics. They collaborate with payor partners to ensure data alignment and lead pilots to innovate the model of care.
Lead the end-to-end revenue recognition and patient accounting processes for Aspen Dental, ensuring compliance with GAAP and accounting standards. Establish internal controls, build allowance and collection models, and serve as a strategic liaison between RCM, IT, and external auditors.
Prior Authorization Coordinator I
MedImpact Healthcare Systems, Inc.
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Full Time
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16 hours ago
MedImpact Healthcare Systems, Inc.
Processes prior authorization requests for pharmaceutical claims according to clinical protocols and client guidelines. Coordinates with pharmacists and external providers to obtain missing information and communicate determinations.
Patient Services Specialist | Remote Work Available
Monument Health
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Full Time
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16 hours ago
Monument Health
Manage pre-arrival prior authorization services to ensure patients have financial clearance and insurance verification before medical services. Coordinate with healthcare providers and payers to secure necessary approvals and prevent delays in patient care.
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Lead and manage a team of multispecialty account managers to build relationships with key customers in community healthcare settings. Develop strategic account plans to drive revenue growth and ensure customer satisfaction through a consultative business advisory approach.
Drive patient impact by serving as the primary contact for healthcare customers in the Dallas South territory. Develop and execute territory business plans while maintaining product knowledge to align customer needs with company solutions.
Drive patient impact by serving as the primary contact for healthcare customers in the San Antonio territory. Develop and execute territory business plans while collaborating with internal teams to deliver patient-focused solutions.
The Referral Coordinator manages administrative requirements for patient referrals between providers and health plans. They serve as a resource for insurance guidelines and interpret medical policies to ensure efficient healthcare operations.
Drive patient impact by serving as the primary scientific contact for healthcare customers within the Dallas North territory. Develop and execute territory business plans while maintaining strong relationships with cardiologists and other healthcare professionals.
Drive patient impact by serving as the primary contact for healthcare customers within the Waco, TX territory. Develop and execute territory-level business plans while maintaining strong relationships with cardiologists and other healthcare professionals.
Drive patient impact by serving as the primary contact for healthcare customers within the assigned Texas territory. Develop and execute business plans while collaborating with internal teams to deliver patient-focused cardiovascular solutions.
Administers the quality management system to review clinical processes, documentation, and patient records while ensuring compliance with regulatory requirements. Responsibilities include managing rework queues, troubleshooting failed claims in RxClaim, and identifying trends for process improvement.
The UM Nurse Consultant assesses and coordinates healthcare services for members by applying clinical criteria and guidelines to render coverage determinations. They collaborate with providers and internal constituents to facilitate treatment and promote quality effectiveness of benefit utilization.
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Responsible for submitting accurate billing to payers and following up on claims to ensure timely reimbursement. The role involves resolving denials, underpayments, and payment delays while maintaining compliance with regulatory standards.
Manage a book of business for Concierge and Advisory customers to drive retention and strategic growth. Partner with clients to define success, monitor health via usage data, and collaborate with internal teams to deliver maximum value.
The UM Nurse Consultant assesses and coordinates healthcare services for members by applying clinical criteria and guidelines to render coverage determinations. They collaborate with providers and internal constituents to facilitate appropriate treatment and promote quality effectiveness of benefit utilization.
The role focuses on acquiring new small business accounts through prospecting, cold-calling, and networking within a specific territory. Responsibilities include analyzing customer needs to provide tailored wireless solutions and managing the sales funnel via automation tools.
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