• Define, own, and evolve the AI product roadmap for healthcare claims solutions—spanning claims adjudication automation, claims adjustment, payment integrity, COB/subrogation, provider issue resolution, and FWA detection. • Translate complex claims operational challenges into AI-first product strategies with clear business cases, ROI frameworks, and measurable KPIs (e.g., auto-adjudication rate, denial accuracy, overpayment recovery yield). • Drive solutions from ideation → POC → MVP → production scale, using agile execution and business-centric prioritization. • Maintain a competitive landscape matrix and continuously benchmark against market players (Optum/Change Healthcare, Cotiviti, Cognizant TriZetto, HealthEdge, Conduent, etc.) to inform differentiation strategy. • Partner with sales, finance, and leadership to determine pricing, packaging, and go-to-market approach (managed services, SaaS, outcome-based/gainshare models). • Drive the transition from traditional rules-engine claims processing to AI-augmented adjudication—automating claim edits, benefit configuration interpretation, provider contract parsing, and payment rule application. • Apply deep knowledge of end-to-end claims operations—claim intake, edits, adjudication, pricing, payment, adjustment, appeals, grievances, provider disputes, and overpayment recovery—to identify high-impact AI use cases. • Embed AI solutions into core claims platforms and systems (QNXT, Facets, Amisys, HealthRules Payer, CSC/DXC, etc.) through platform-agnostic integration and API-first design.

• Support a healthcare practice with prior authorizations, referrals, patient communication, medication refills, insurance verification, and administrative coordination. • Submit, track, and follow up on insurance authorization requests. • Coordinate with insurance companies regarding approvals, denials, and required documentation. • Review authorization requirements and ensure all supporting information is submitted. • Monitor pending authorizations and provide status updates to providers and staff. • Process and send referrals to specialists and healthcare facilities. • Coordinate referral documentation and follow-up. • Ensure referrals are completed accurately and timely. • Communicate with specialty offices regarding referral status and scheduling. • Answer incoming patient phone calls professionally. • Return patient callbacks and follow-up inquiries. • Assist patients with appointment-related concerns and clinical requests. • Process electronic medication refill requests. • Schedule and reschedule patient appointments. • Send appointment reminders via phone and text. • Verify insurance eligibility and benefits. • Assist with insurance-related inquiries and documentation. • Send and receive required faxes and clinical documents. • Monitor KPIs for timely completion of prior authorizations and referrals, reliable availability during business hours, and efficient turnaround time for insurance and referral requests.

Manage calendars and scheduling efficiently. Coordinate travel arrangements, including accommodations and itineraries. Oversee social media management and engagement. Create professional PowerPoint presentations. Handle invoicing and manage payment...

Role Description "Navitas Healthcare, LLC" is seeking an experienced Virtual Care Coordinator to support hospital-based telehealth and remote patient monitoring programs. The role focuses on continuous virtual observation, patient safety monitoring, coordination with clinical teams, and supporting telehealth operations and technology systems to ensure high-quality virtual care delivery. - Monitor patients remotely for safety, clinical changes, and early warning signs - Provide continuous virtual observation to prevent falls and ensure patient safety - Triage and assign cases for virtual monitoring and escalation - Communicate patient status changes immediately to RN or physician - Document patient behavior, interventions, and escalation details accurately - Support telehealth consultations, scheduled visits, and remote monitoring workflows - Ensure telehealth sessions start and run smoothly using approved platforms - Collaborate with physicians, nurses, IT teams, and vendors to resolve technical issues - Provide real-time “white glove” support for telehealth platform troubleshooting - Monitor Epic telehealth consults and documentation workflows - Support quality assurance, peer reviews, and program performance tracking - Assist in policy development, workflow improvements, and training of new staff - Maintain patient privacy and comply with HIPAA and hospital policies - Participate in meetings, reporting, and quality improvement initiatives Qualifications - Minimum 3 years of direct patient care experience - At least 2 years of telehealth or remote monitoring experience required - Experience with electronic medical records (Epic preferred) - Strong understanding of clinical escalation and patient safety indicators - Experience in quality improvement, data tracking, or clinical workflow development - Strong communication, multitasking, and problem-solving skills - Ability to work in fast-paced virtual clinical environment (night shift) - Associate or Bachelor’s degree in a health-related field preferred Company Description It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.