- Mathematica (Boston, MA)
- …number of areas related to providing policy or programmatic implementation and monitoring support focused on improving Medicaid programs. Key areas include but ... beneficiaries, and outcomes of innovative programs and policies. Additionally, Medicaid analysts will work on or support ...analysis and writing, such as a white paper or decision memo. You will also be asked to provide… more
- Commonwealth Care Alliance (Boston, MA)
- …Sr. Director, TPA Management and Claims Compliance, the Payment Integrity (PI) Recovery Analyst will assist in the development of a strategic roadmap to recover, ... eliminate, and prevent unnecessary medical expense spending and support the execution for a comprehensive claim accuracy program. The individual will optimize… more
- Public Consulting Group (Boston, MA)
- …and distribute work within the Quality Assurance team. + Provide supervision and support for junior staff. + Contribute to decision -making and goal-setting for ... **Quality Assurance and Control** + Assist with quality assurance processes surrounding Medicaid cost settlement and supplemental payment work. + Review and improve… more
- Prime Therapeutics (Boston, MA)
- …and drives every decision we make. **Job Posting Title** Senior Actuarial Analyst - Remote **Job Description** The Senior Actuarial Analyst is responsible ... for all Prime's lines of business (commercial, Medicare and Medicaid ). This role will also provide actuarial support... Medicaid ). This role will also provide actuarial support in complex projects that are highly visible to… more
- Humana (Boston, MA)
- …community and help us put health first** The Senior Market Finance Analyst (Professional) collects, analyzes, and reports on various market data, connecting ... Provider Contracting, Provider Engagement, Actuarial, and Medicare Risk Adjustment internally in support of Humana's efforts to partner with providers to help our… more
- Highmark Health (Boston, MA)
- …resolution to members in accordance with Center for Medicare and Medicaid Services (CMS) requirements. Requires broad knowledge of plan products, processes ... Responsible for all aspects of nonclinical appeals , up to and including decision making, considering potential impacts to regulatory compliance as well as CMS star… more
- Public Consulting Group (Boston, MA)
- …advanced levels of Excel required; Experience with or knowledge of Medicaid , Healthcare, Education, and/or customer support is beneficial. Certification ... within the Quality Assurance team. + Provide supervision and support to junior staff members of the Quality Assurance...various product lines and projects. + Participate in the decision -making process and in goal-setting for the overall team.… more
- Commonwealth Care Alliance (Boston, MA)
- …that impact payment methods, billing/coding or rates, and help drive analytics to support decision making. **Supervision Exercised:** + No, this position does ... corporate reimbursement policies, and works collaboratively with the Claims Coding Analyst to ensure consistency with the Plan's claims processing system(s) +… more
- Prime Therapeutics (Boston, MA)
- …not lose sight of that. It fuels our passion and drives every decision we make. **Job Posting Title** Manager, Quality Assurance (Remote) **Job Description Summary** ... lines of business (Medicare Part D, Employer, Government, Coupons, Managed Medicaid , Migrations, etc.) to ensure benefit plans are programmed appropriately and… more
- Humana (Boston, MA)
- …and help us put health first** We are looking for an EMR interface analyst to support seamless integration and interoperability between various systems as PCO ... (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and… more