- Point32Health (Canton, MA)
- …about who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** As a Medical Audit Claim Reviewer , you will play a ... you will be doing** + Review and audit medical claims to ensure...**:** + Required (minimum): 5-7 years of experience in medical claim auditing, healthcare compliance, or a… more
- Elevance Health (Woburn, MA)
- …procedures. + Investigates potential fraud and over-utilization by performing the most complex medical reviews via prepayment claims review and post payment ... of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review… more
- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve ... fast-paced, collaborative environment and will bring your expertise to review and carry out processes on all out of...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- HealthEdge Software Inc (Boston, MA)
- … life cycle/workflow, network contracting, payment/policy configuration, provider relations, medical management, medical economics, audit , compliance) ... life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit ,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …member and provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims processing, ... to provider inquires and appeals, build cases, and perform claim adjustments in a dual system environment. This manager...partnership with key business partners, such as the physician review unit, health and medical management, network… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Extensive background of ICD-9 and CPT coding principles + Extensive knowledge of medical claim editing (NCCI, etc.) + Experience working with industry standard ... and commercial coding rules/ regulatory requirements + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims ,… more
- Commonwealth Care Alliance (Boston, MA)
- …experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims , ... a strategic roadmap to recover, eliminate, and prevent unnecessary medical expense spending and support the execution for a...claim accuracy program. The individual will optimize pre/post claims auditing and claim recovery programs that… more
- Beth Israel Lahey Health (Burlington, MA)
- …ensure successful initial submission. The Billing Specialist will be responsible for charge and claim review to ensure the correct information is on the claim ... and Managers to obtain required information. Additional tasks include researching medical policies, payer billing guidelines, claim requirements, and written… more
- Beth Israel Lahey Health (Danvers, MA)
- …ensure successful initial submission. The Billing Specialist will be responsible for charge and claim review to ensure the correct information is on the claim ... and Managers to obtain required information. Additional tasks include researching medical policies, payer billing guidelines, claim requirements, and written… more
- Walgreens (Allston, MA)
- …issues and prevent payment rejections. Follows- up with insurance companies as well as medical providers and participates in 3rd party audit . + Follows-up with ... as immunizations. Responsible for ensuring the proper compounding, dispensation, review and verification of prescribed medications within regulatory guidelines,… more
- Walgreens (Boston, MA)
- …patient issues and prevent payment rejections. Follows up with insurance companies and medical providers and participates in 3rd-party audit . + Follow-up with ... outcomes services. Responsible for ensuring the proper compounding, dispensation, review , and verification of prescribed medications within regulatory guidelines,… more
- Walgreens (Boston, MA)
- …issues and prevent payment rejections. Follows-up with insurance companies as well as medical providers and participates in 3rd party audit . + Follows-up with ... as immunizations. Responsible for ensuring the proper compounding, dispensation, review and verification of prescribed medications within regulatory guidelines,… more
- Harvard University (Cambridge, MA)
- …and documentation are required as a condition of employment at HUHS. You may claim exemption from the vaccine requirements for medical or religious reasons. ... sponsorship. + This position has a 90-day orientation and review period. Department:Executive OfficePre-Employment Screening:Criminal, Education, IdentityJob Function:General Administration,… more
- KPMG (Boston, MA)
- …for being a great place to work and build a career, KPMG provides audit , tax and advisory services for organizations in today's most important industries. Our growth ... Contracting Center (ECC) to oversee and manage a portfolio of Commercial Audit contracts; implement firm policies and procedures and provide guidance requiring… more
- RTX Corporation (Woburn, MA)
- …provides advice and drafting support for purchasing professionals and will: review purchase order/subcontract terms and conditions in compliance with applicable ... assist in negotiations regarding deviations from standard provisions + Review and advise SC on performance issues such as... and advise SC on performance issues such as claims and insolvency + Assist the organization in writing… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …state courts and in administrative hearings concerning a wide variety of legal claims . The attorney will also interact with other business areas to effectuate ... of a team of senior managers, data analysts, fraud investigators, certified coders and medical providers. + Manage strategy, goal setting and budget for the FIP Unit… more
- Takeda Pharmaceuticals (Boston, MA)
- …support to Local Affiliates for responses to health authorities requests, review of local labeling exceptions and alignment deferrals, etc. Escalation Process ... at the Labeling cross functional teams including clinical, safety, medical affairs, and commercial, to ensure the highest level...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- Walgreens (East Boston, MA)
- …Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... insurance companies as well as medical providers and conducts or participates in 3rd party audit . + Assists and supports Store Manager and Pharmacy Manager in… more