- 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to demands and strict timelines in a fast-paced environment + Proficient understanding of medical coding and medical record reviews + Demonstrates analytical ... Prevention Unit ("FIP"). The position will be a dedicated coding specialist reviewing medical records to identify...and abuse and to facilitate accurate claim payments. The coding specialist will conduct pre-payment reviews of claims… 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
- 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
- Beth Israel Lahey Health (Charlestown, MA)
- …prospective reimbursement system. . Ability to review and analyze issues related coding , billing and medical record documentation. . Excellent interpersonal and ... all applicable federal and state laws and regulations as they pertain to coding , billing, and documentation. To educate, give support, and provide guidance to all… 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
- 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
- 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
- Cardinal Health (Boston, MA)
- …+ Clear knowledge of Medicare (A, B, C, D) + 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience is preferred + 1-2 years ... additionally follow up if requested to do so. + Responsible for addressing Medical Information inquiries from consumers, healthcare providers and other entities,… more
- Cardinal Health (Boston, MA)
- …of healthcare data, including clinical data, patient demographics, and claims data. Understanding of HIPAA and other relevant regulations, preferred. + Cloud ... Center of Excellence (AI CoE), we are pushing the boundaries of healthcare with cutting-edge Data Science and Artificial Intelligence (AI). Our mission is… more
- Mathematica (Boston, MA)
- …commercial, Medicare, Medicaid, or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding ). * Ability to describe difficult ... data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and… more
- CVS Health (Boston, MA)
- …Experience in healthcare fraud, waste and abuse + Knowledge of healthcare claims adjudication & provider information + Experience with financial calculations ... healthcare industry + Solid understanding and experience interpreting medical claim data + Advanced experience in SAS ...medical claim data + Advanced experience in SAS coding sourcing from a data warehouse + 5+ years… more
- Prime Therapeutics (Boston, MA)
- …Management) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical , and/or financial data + Basic to intermediate SAS ... in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare , financial services or related field + Must be...coding skills + Previous experience in a client facing… more