Jobs at Nova Healthcare Administrators, Inc.

The Case Manager assesses patients’ medical, social, and psychosocial needs; develops, coordinates, monitors, and evaluates individualized care plans; advocates for patients; identifies barriers and alternative care resources; coordinates with providers, payors, and interdisciplinary teams; ensures regulatory, privacy, reimbursement, and documentation compliance; and supports quality improvement, staff training, and community resource connections.

Prepares and reviews financial statements, journal entries, reconciliations, audit schedules, tax reporting, and consolidated reporting. Maintains the general ledger, investigates variances, supports month-end close, and develops financial reports in Workday. The role also improves accounting processes, supports strategic initiatives and system upgrades, tests finance interfaces, trains staff, and mentors accounting personnel.

Manages employer group and member account operations for a health plan, including enrollment, eligibility, implementations, plan changes, data exchanges, billing-related issues, and account maintenance. Serves as the primary contact for employers, members, brokers, and partners; provides education and support; researches complex plan and claims issues; resolves discrepancies; and escalates fraud, compliance, sales, and operational concerns.

Manage retention and profitable growth for self-funded employer health plan accounts. Build relationships with employers, brokers, consultants, and decision-makers; develop account strategies; analyze medical plan performance; recommend solutions; lead client implementation and enrollment presentations; coordinate reporting, vendors, events, and value-added programs. The role includes local travel, community and employer events, occasional after-hours and weekend work, and achievement of productivity goals.

Senior Clinical & Coding Specialist reviews complex inpatient coding and clinical cases, conducts audits, validates diagnosis/procedure coding, manages appeals and external dispute processes, trains staff, analyzes audit trends, recalculates reimbursement, and presents audit results to leadership.

Integrate multiple healthcare data sources to produce reports and complex analyses of quality measure trends, support HEDIS/QARR submissions, model gap-closure opportunities, develop custom measures, present findings, validate data, and lead improvement initiatives while mentoring junior analysts.

Prepare and review journal entries, monthly/annual financial statements (GAAP and SAP methods), reconciliations and variance analyses. Generate audit schedules and management reports using Workday/report writers, investigate and resolve month-end differences, support tax return preparation, and improve accounting processes to meet deadlines.

Manage projects end-to-end using Waterfall, Agile, or hybrid approaches. Define scope, schedule, budget, risks, and success criteria; lead cross-functional teams; facilitate ceremonies and stakeholder communication; support business readiness, change management, and continuous improvement; ensure documentation, governance compliance, and transition to operations.

Provide phone-based support to healthcare providers: answer benefit/eligibility, billing, payment, and EOB questions; research and resolve escalated claims inquiries; document contacts; meet call center quality and productivity standards; escalate as needed and educate providers on errors and system/billing issues.

Perform QA audits and monitoring across lines of business to ensure regulatory compliance (CMS, NYS DOH, NYS DFS), develop and run manual/automated tests, log and track defects, produce reports, conduct internal audits, analyze trends, and collaborate with cross-functional teams to remediate findings and improve processes.