- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the creation of controls to manage fraud, waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse ... Prevention (FIP) Unit including management of a team of senior managers, data analysts, fraud investigators, certified coders and...on fraud waste and abuse work, present to the Medicare Compliance Committee and manage requests and… more
- Prime Therapeutics (Boston, MA)
- …passion and drives every decision we make. **Job Posting Title** Regulatory Analyst Sr - Remote **Job Description** The Senior Regulatory Analyst is responsible ... processes, and participates in committee review meetings within the Commercial, Medicare , Medicaid, and Health Insurance Marketplace for the assigned department.… more
- Cardinal Health (Boston, MA)
- …* Process all patient applications in accordance to set policy, procedures and PHI compliance * Speak with manufacturer field team members on case updates via phone ... * Pharmacy benefits management experience preferred with specific knowledge of Medicare , Medicaid and commercially insured payer common practices and policies,… more
- Point32Health (Boston, MA)
- …who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** This Senior Actuarial Analyst will support the Medicare Part C Pricing ... you will be doing** + Support the preparation, analysis, and submission of Medicare Advantage bids, ensuring compliance with CMS regulations. + Maintain current… more
- Commonwealth Care Alliance (Boston, MA)
- …Department Regulatory Affairs and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid ... Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an… more
- Point32Health (Canton, MA)
- …who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Compliance Senior Manager will report to the Government ... with healthcare program requirements. + **Collaboration:** At the direction of the Medicare Compliance Officer, collaborate with leadership and department heads… more
- Robert Half (Boston, MA)
- …global consulting firm. Where We Need You Protiviti is looking for a Risk and Compliance Senior Manager to join our growing Healthcare team. Protiviti's ... REQUISITION Risk and Compliance - Healthcare - Senior Manager LOCATION BOSTON ADDITIONAL LOCATION(S) NEW...healthcare payer regulations and guidance with emphasis on the Medicare Managed Care Manual. + Expertise of core business… more
- US Tech Solutions (Malden, MA)
- …area** Under the administrative direction of the Clinical Manager , the Nurse Case Manager (NCM) for Senior Care Options (SCO) is responsible to manage all ... required. Experience within a SCO program highly preferred. Experience in Medicare and/or Medicaid managed care preferred. Proficient in computer use, the… more
- Cambridge Health Alliance (Cambridge, MA)
- …Center for Medicare and Medicaid Services. In this role the Manager , Accreditation & Regulatory Compliance proactively plans, implements, coordinates and ... Manager , Accreditation & Regulatory Compliance Apply...mission of our organization. Under the direction of the Senior Director of Risk Management & Patient Safety, and… more
- Fallon Health (Boston, MA)
- …in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare benefits, including prescription ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Beth Israel Lahey Health (Boston, MA)
- …with any changes in ICD-10 and CPT-4 coding and remains current with Medicare , federal insurance and third party billing compliance regulations. Works ... descriptor codes including the appropriate use of modifiers to ensure compliance for reimbursement. Please note this role has remote work eligibility… more
- Spaulding Rehabilitation (Charlestown, MA)
- …completeness and accuracy of medical record documentation for the purposes of ensuring compliance with Medicare , Medicaid (CMS) regulations and guidelines and to ... CDI operations + In collaboration with the Spaulding Coding Manager , assures compliance with Official Coding Guidelines,...of CDI reports including key CDI program metrics to senior management + Approve PTO requests, assuring adequate staff… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of Trustee approved goals and regulatory and standard setting agencies. The Risk Manager performs as an internal compliance consultant by maintaining current ... The Risk Manager is a member of the Patient Safety...level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The… more
- Point32Health (Canton, MA)
- …be expected to develop conclusions based on data findings under guidance from the Manager . The Analyst will also create project plans and ensure that the product ... research and internal data to analyze market and product data across all Medicare market segments in all states to develop strategies to enhance existing products… more
- Elevance Health (Boston, MA)
- …providing strategic legal advice to support business objectives and to ensure compliance with applicable laws, rules, regulations, and guidelines. + Partner closely ... various brands and legal entities in marketing efforts + Partner closely with compliance and other legal subject matter experts to ensure that marketing materials… more
- Commonwealth Care Alliance (Boston, MA)
- …Department Regulatory Affairs and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid ... and vendors, as assigned. Apply auditing expertise to report on compliance with established internal control procedures by examining records, reports, operating… more
- Fallon Health (Waltham, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... with the goal to enhance the Behavioral Health Case Manager 's and Social Care Manager 's ability to...community transportation, food programs, and other services available through senior centers and other external partners. + Helps to… more
- US Tech Solutions (Somerville, MA)
- …Under the administrative direction of the Clinical Manager , the Nurse Case Manager (NCM) for Senior Care Options (SCO) is responsible to manage all ... for candidates who are able to serve the following locations:** **Boston Senior Home Care** **Areas served: Boston neighborhoods of Beacon Hill, Boston, Charlestown,… more
- CenterWell (Boston, MA)
- …seeing consistency in the content. The Copywriter 2 (VSP/PT) collaborates with Legal and Compliance for both our Medicare and Medicaid lines of business. The ... at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more