- CenterWell (Boston, MA)
- …be the ambassador for value-based, senior care model in the primary care network. The Associate Director , Clinical Coding Education (RN) will develop, ... addition to managing a team of role-based trainers and training facilitators. The Associate Director , Clinical Coding Education (RN) role will report to… more
- Humana (Boston, MA)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical … more
- Humana (Boston, MA)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Operations Center projects to advance team functionalities. This position reports to the Associate Director of FEP Operations. Key Accountabilities: + Lead and ... clinical (RN) reviewers and offers guidance on clinical and coding integrity reviews that are...and ownership + Offer opportunities for continuous learning and associate engagement + Build bench strength to secure talent… more
- Beth Israel Lahey Health (Boston, MA)
- …disputes, listens attentively to patient concerns, works with coders requesting coding documentation review to determine correct code(s) selection, provides patient ... of payer prior authorization forms, faxing completed PA forms and all necessary clinical documentation to the payer for review, records prior authorization #, when… more
- Beth Israel Lahey Health (Beverly, MA)
- …of Beverly. **Job Description:** Position Summary: Under the direction of the Director and/or Manager of Patient Access Services Call Center performs the function ... and communicates and coordinates with revenue cycle peers, leadership and clinical stakeholders. Documents interim and final results in appropriate systems.… more