Full-Time

Associate – Clinical Policy Specialist

Confirmed live in the last 24 hours

Cohere Health

Cohere Health

501-1,000 employees

Automates prior authorization in healthcare

AI & Machine Learning
Healthcare

Compensation Overview

$50k - $60kAnnually

+ Bonus + Health Insurance + 401k

Entry

Remote in USA

Category
Risk & Compliance
Legal & Compliance
Required Skills
Word/Pages/Docs
Requirements
  • Bachelor's Degree (BA/BS) required
  • 6 months of related experience working for a payer or multi-specialty provider organization, or comparable experience with a healthcare technology or managed services vendor.
  • Tech savvy and detail oriented
  • Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive)
  • Understanding of medical terminology, procedures, and diagnoses
  • Knowledge of common disease processes, treatments, and tests
  • Strong communication skills, listening effectively and asking for clarification when necessary
  • Ability to work independently and as part of a team
  • Passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
  • Self-directed, confident, and thrive working in a fast-paced startup environment.
Responsibilities
  • Review healthcare policy documentation and data for discrepancies and missing information and resolve discrepancies
  • Enter healthcare policy data including policy text, procedure codes, and diagnosis codes into Cohere Health’s product
  • Perform routine quality assurance checks
  • Implement solutions that help our internal teams comply with regulations for medical services
  • Prepare educational materials on updates to internal customers
  • Contribute ideas on how to best organize and represent information based on internal customer and product needs

Cohere Health improves the prior authorization process in healthcare, which requires providers to get approval from health plans before delivering certain services. Their platform, Cohere Unify, automates and streamlines these requests by integrating with electronic medical records and using machine learning to speed up decision-making. This approach sets them apart from competitors by offering a Platform-as-a-Service model that health plans can license for their internal teams. The goal is to make the prior authorization process more efficient, benefiting patients and reducing costs for healthcare providers and health plans.

Company Stage

N/A

Total Funding

$103.1M

Headquarters

Boston, Massachusetts

Founded

2019

Growth & Insights
Headcount

6 month growth

9%

1 year growth

19%

2 year growth

64%
Simplify Jobs

Simplify's Take

What believers are saying

  • Cohere Health's recent $50 million equity raise indicates strong investor confidence and provides ample resources for further innovation and expansion.
  • The expansion of its partnership with Humana to cover diagnostic imaging and sleep services demonstrates the platform's scalability and effectiveness.
  • Being named a 2024 Built In Best Place to Work highlights a positive company culture, which can attract top talent and drive further growth.

What critics are saying

  • The digital health market is highly competitive, and maintaining a technological edge requires continuous innovation and investment.
  • Dependence on large partnerships, such as with Humana, could pose risks if these relationships were to change or dissolve.

What makes Cohere Health unique

  • Cohere Health's Cohere Unify platform uniquely integrates with EMRs and uses OCR to handle fax submissions, setting it apart from competitors who may not offer such comprehensive automation.
  • The company's focus on responsible AI and machine learning for automating prior authorization decisions ensures compliance with health plan policies, providing a competitive edge in accuracy and reliability.
  • Cohere Health's recognition through awards like the 2021 TripleTree iAwards and the KLAS Points of Light Award underscores its industry leadership and innovative approach.

Help us improve and share your feedback! Did you find this helpful?