- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. - Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Commonwealth Care Alliance (Boston, MA)
- …and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital , behavioral health, ... Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. * Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Beth Israel Lahey Health (Westwood, MA)
- …difference in people's lives.** Under the direction of the Manager, Provider Enrollment completes enrollment and health plan recredentialing applications. Maintains ... resource to providers, practice staff, BIDCO staff and health plan provider representatives concerning health care plan participation and status. Demonstrates… more
- Option Care Health (Boston, MA)
- **Extraordinary Careers. Endless Possibilities.** **With the nation's largest home infusion provider , there is no limit to the growth of your career.** Option Care ... the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team...and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a… more
- Humana (Boston, MA)
- …- 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts. + Proficiency in analyzing, understanding ... part of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts… more
- Cambridge Health Alliance (Somerville, MA)
- …Healthcare Providers BLS (Basic Life Support) certification is required + Experience: Hospital Care Management Experience strongly preferred. + Provider Minimum ... medical illness. Casework or therapy takes place in the hospital setting. Summary: Under the general supervision of the...and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case… more
- Oracle (Boston, MA)
- …focus more on patient care by reducing administrative burden of clinical and reimbursement tasks such as charting, documentation, and coding by applying power of ... opportunities to prevent future denials, and ensure maximum appropriate reimbursement . This role is critical for financial recovery and...on experience preparing appeals for claim denials in the hospital and ambulatory setting + 3+ years hands on… more
- Molina Healthcare (Boston, MA)
- …modeling current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. + Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Epic and/or other comparable software and database tools. + Knowledge of hospital operations, reimbursement , and applicable regulatory requirements. + Ability to ... integrity, accuracy, and regulatory compliance of Dana-Farber Cancer Institute's hospital and professional billing through data-driven audits and targeted… more
- Cambridge Health Alliance (Cambridge, MA)
- …10782 **Pay Range:** $41.58 - $93.96 per hour **Location** : CHA Cambridge Hospital **Work Days** : Mon-Fri; 8:00-4:30, rotating weekends and holidays **Category** : ... medical illness. Casework or therapy takes place in the hospital setting. Cross Training to all areas of Care...and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case… more
- Cambridge Health Alliance (Everett, MA)
- …10687 **Pay Range:** $41.58 - $93.96 per hour **Location** : CHA Everett Hospital **Work Days** : Mon - Friday and Rotating Weekends/Holiday **Category** : ... medical illness. Casework or therapy takes place in the hospital setting. Cross Training to all areas of Care...and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case… more
- Humana (Boston, MA)
- …for services rendered is complete, compliant and accurate to support optimal reimbursement . The Nurse Auditor 2 work assignments are varied and frequently require ... in the state they reside. + Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not… more
