- Commonwealth Care Alliance (Boston, MA)
- …under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible ... Degree **Required Experience (must have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding … more
- Humana (Boston, MA)
- …**Where you Come In** Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle ... community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from...payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments.… more
- LogixHealth (Bedford, MA)
- …ien ce: Priorex pe r ie nce an dpro fi c ie ncywith MS Exc el and medical background r eq uired Coding experience and/or certification is a plus. Spe cificJ ob ... management services, offering a complete range of solutions, including coding and claims management and the latest...we have had a clear vision of a better healthcare system and have continually evolved to get there.… more
- LogixHealth (Bedford, MA)
- …Diploma or equivalent combination of education and experience required 2. Baseline knowledge of medical coding or currently in a certification program is a plus ... management services, offering a complete range of solutions, including coding and claims management and the latest...we have had a clear vision of a better healthcare system and have continually evolved to get there.… more
- Elevance Health (Woburn, MA)
- …**Evaluation and Management Coding /Auditing)** ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... are not limited to: + Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules, as well as… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and… more
- Atrius Health (Chelmsford, MA)
- …Bachelor's degree (or equivalent education, training or experience) required. o Certification in medical coding is preferred including CCS, CCS-P, CPC or other ... of complex medical necessity and billing policy related to denied claims for all payers. In accordance with department policies and procedures responsible for… more
- Humana (Boston, MA)
- …studies and the strategic interpretation of data, the mission of Humana Healthcare Research (HHR) is to produce high-quality, actionable evidence and rigorous, ... community and society at large. HHR maintains external partnerships with healthcare industry, government, academia and others to produce research important to… more
- LogixHealth (Bedford, MA)
- …revenue cycle management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting ... Billing Specialist at LogixHealth, you will work with a team of fellow medical billers, administrators, and coders to provide cutting edge solutions that will… more
- LogixHealth (Bedford, MA)
- …prior word processing, spreadsheet, and internet software experience Preferred: + Prior medical Billing/ Coding experience preferred + One or more years related ... management services, offering a complete range of solutions, including coding and claims management and the latest...we have had a clear vision of a better healthcare system and have continually evolved to get there.… more
- LogixHealth (Bedford, MA)
- …Preferred: + One to two years related experience + Experience with document management, medical records, or a coding background + Electronic medical record ... collaborative environment and will bring your expertise to process medical records that have been reviewed by Coders and...management services, offering a complete range of solutions, including coding and claims management and the latest… more
- Tufts Medicine (Boston, MA)
- …meetings with clinical and administrative staff educating on billing issues. 11. Regularly works Coding Denial WQs to correct and resubmit claims on a timely ... to pay attention to detail 4. Familiarity with electronic medical record systems and billing and coding ...system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences… more
- Humana (Boston, MA)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- Conviva (Boston, MA)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- LogixHealth (Bedford, MA)
- …and will bring your expertise to facilitate payment of Emergency Department Physician medical claims . The ideal candidate will have strong technical skills, ... a daily basis + Attach primary EOBs to secondary claims + Attach medical records to ...management services, offering a complete range of solutions, including coding and claims management and the latest… more
- Tufts Medicine (Lowell, MA)
- …system tools to resolve accounts, including Patient Access, Revenue Integrity, Coding , Medical Records, Utilization Review, Hospital Departments, Physician's ... eligibility verification, claim edits, payer follow-up, correspondence review, corrected claims , appeals, reimbursement verification, and remittance research for assigned… more
- CVS Health (Boston, MA)
- …regulations. Stay informed about changes in the industry practices related to healthcare coding . Provide training opportunities for staff to maintain their ... healthcare fraud detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to … more
- Elevance Health (Woburn, MA)
- …strongly preferred. + Prior health care fraud audit/investigation experience preferred. + Medical claims review with prior health care fraud audit/investigation ... and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment claims review, post-payment auditing, and… more
- Humana (Boston, MA)
- …operational efficiency, reduce manual processes, and improve accuracy in insurance claims processing, policy management, and other key areas. A strong background ... in business process management (BPM) within the healthcare insurance industry is preferred. We are seeking an experienced Lead Automation Engineer within the… more
- CVS Health (Boston, MA)
- …thoroughness and accuracy of investigations aimed at preventing payment of fraudulent claims by insured individuals, providers, claimants, etc. + Analyze and prepare ... agencies to ensure compliance and support the prosecution of healthcare fraud and abuse matters. + Demonstrate a high...or fraud, waste and abuse. + Knowledge of CPT/HCPCS/ICD coding . + Proficiency in Microsoft Word, Excel, Outlook, database… more