Jobs at Nova Healthcare Administrators, Inc.

Manages strategic and operational projects from initiation through closure, including scope, timelines, budgets, resources, risks, dependencies, requirements, and stakeholder communication. Leads cross-functional teams, facilitates decision-making, develops status reports, escalates issues, and supports enterprise project governance. Applies business analysis skills to elicit requirements, define functional specifications or user stories, validate solutions, conduct gap analyses, and implement process improvements.

Designs, delivers, and improves new-hire, departmental, staff-development, and update training programs. Creates curricula, guides, assessments, and handbooks; facilitates training sessions; evaluates trainee performance; supervises new-hire classes; coordinates onboarding and training schedules; maintains department resources; and collaborates with HR, quality assurance, resource management, and other departments on organizational initiatives.

Prepares and dispenses medications, including sterile admixtures, while providing clinical pharmacy care to assigned patients. Evaluates therapy appropriateness, monitors drug interactions and outcomes, performs renal dosing and pharmacokinetic monitoring, counsels patients, coordinates with healthcare providers, maintains documentation, manages supplies and controlled substances, and supports quality assurance and pharmacy team operations.

Analyzes healthcare quality data from claims, membership, provider, EMR, ADT, and risk-score sources. Develops reports, dashboards, forecasts, quality measure models, and gap-closure analyses; validates findings and communicates recommendations. Supports HEDIS and QARR submissions, regulatory reporting, auditor responses, performance improvement initiatives, new data-source integration, and cross-functional quality workgroups.

Adjudicates and adjusts medical and dental claims according to client plan criteria, policies, coding requirements, and regulations. Reviews payment explanations, researches coding and benefit issues, resolves claim discrepancies, responds to member, provider, and client inquiries, and meets productivity, accuracy, and timeliness goals. Maintains benefit and contract knowledge, navigates claims systems, manages workload, and communicates with internal departments to resolve payment problems.

The Case Manager assesses patients’ medical, psychosocial, and social needs; develops and monitors care plans; coordinates interdisciplinary providers, payors, community resources, and alternative care services; advocates for patients; evaluates quality and cost effectiveness; ensures regulatory, privacy, reimbursement, and documentation compliance; and supports care management training and staff development.

Analyzes healthcare utilization, claims, membership, cost, provider network, reimbursement, and pricing data to support contract negotiations and strategic initiatives. Designs statistically sound analytical tools, validates data, interprets trends and reimbursement impacts, and presents recommendations to management. Evaluates alternative payment models, regulatory changes, policy impacts, and provider cost drivers while collaborating across departments and supporting data integrity and administrative platform initiatives.

Develops, negotiates, implements, and maintains healthcare provider contracts and amendments. Coordinates with legal, credentialing, reimbursement, finance, and other teams to ensure regulatory compliance, accurate fee schedules, timely contract execution, provider servicing, and resolution of network issues. Supports audits, provider outreach, network development, operational initiatives, documentation, and cross-functional projects. This is a hybrid role requiring onsite attendance in Williamsville.

Directs facility provider network contracting, reimbursement strategy, contract negotiations, analytics, rate amendments, and operational relationship management. Leads reimbursement methodology development, integrates payment methods into system configurations and claims processes, monitors regulatory and payer trends, and presents recommendations to executive leadership. Manages and develops staff supporting hospital, ambulatory surgery center, skilled nursing, and ancillary provider agreements. This is a hybrid role requiring onsite attendance in Williamsville.

Prepares and reviews journal entries, account reconciliations, financial statements, audit schedules, and monthly reports. Maintains general ledger records, investigates variances, supports accounts payable, accounts receivable, and cash management, and ensures accurate GAAP-compliant reporting. The role also assists with accounting research, process improvements, documentation, training, and cross-functional financial initiatives while serving as backup across the accounting department.

Develops data-driven solutions, reports, dashboards, visualizations, and analytical models for a managed healthcare organization. The role validates data, improves processes, automates tasks, establishes data lineage, integrates diverse healthcare data sources, and presents actionable findings to business partners. It also explores AI and machine learning technologies, supports quality and operational improvements, and collaborates with informatics teams while working independently on multiple initiatives.

Performs advanced clinical and contractual claims audits using healthcare coding systems and reimbursement methodologies. Manages inpatient admission and readmission audits, analyzes clinical and financial findings, coordinates reconsideration appeals, recalculates reimbursement, researches coding standards, and presents audit results to leadership. Serves as a coding subject matter expert, supports policy and contract development, leads cross-functional teams, and manages hospital audit process improvements.

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.

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.

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.