• Healthcare Medical Claims

    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
    Commonwealth Care Alliance (11/26/24)
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  • Inpatient Medical Coding Auditor

    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 (12/12/24)
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  • Senior Administrative Lead, Coding

    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 (11/05/24)
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  • Resource Assistant, Coding

    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
    LogixHealth (11/05/24)
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  • Provider Reimbursement Admin (Evaluation…

    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
    Elevance Health (12/21/24)
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  • Medical Director-- Claims Management

    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
    Humana (10/29/24)
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  • Medical Revenue Analyst- Healthcare

    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
    Atrius Health (12/18/24)
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  • Senior Research Scientist, Humana…

    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
    Humana (11/20/24)
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  • Medical Billing Specialist

    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 (11/07/24)
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  • Medical Records Chart Specialist

    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
    LogixHealth (12/05/24)
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  • Senior Quality Applications Manager

    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 (12/14/24)
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  • Professional Charge Entry Analyst

    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
    Tufts Medicine (12/24/24)
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  • Medical Director - Florida

    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
    Humana (12/14/24)
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  • Reviewing Medical Director

    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
    Conviva (12/11/24)
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  • Clerical Assistant, ED Billing

    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
    LogixHealth (09/26/24)
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  • Lead Billing Specialist, Professional Billing…

    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
    Tufts Medicine (12/22/24)
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  • Nurse Audit Senior - Carelon Payment Integrity

    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
    Elevance Health (12/21/24)
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  • Lead Automation Engineer- RPA

    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
    Humana (12/06/24)
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  • Quality Reviewer (Aetna SIU)

    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
    CVS Health (12/06/24)
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  • Charge Entry Clerk, Professional Charge Entry

    LogixHealth (Bedford, MA)
    …revenue cycle management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting ... site, and aliment information for MVA, WC, MD, insurances + Review claims reports and validations; make all corrections to insurance, patient registrations +… more
    LogixHealth (10/18/24)
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