- 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
- Elevance Health (Woburn, MA)
- …locations. The **DRG CODING AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Highmark Health (Boston, MA)
- …for education/training of facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology ... **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data… more
- 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 (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
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Coding Coordinator 3 extracts clinical information from a variety of ... medical codes (eg, ICD-10-CM, CPT) to patient records. The Medical Coding Coordinator 3 performs advanced administrative/operational/customer support duties… more
- Sedgwick (Boston, MA)
- …Medical Malpractice (Professional Liability) To analyze complex or technically difficult healthcare / medical malpractice liability claims ; to provide ... relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases...+ Extensive knowledge and comprehension of insurance coverage + Claims expertise in medical malpractice, errors and… more
- Humana (Boston, MA)
- …or other educational materials, such as billing companion guides, related to claims submission processes, coding updates, etc. + Partners with the ... contracts, including contract language and reimbursement. + Experience with Humana claims systems, adjudication, submission processes, coding , and/or dispute… 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
- 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 (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
- 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 ... data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background,...but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes… 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
- LogixHealth (Bedford, MA)
- … claims generated by staff on a daily basis + Attach primary EOBs to secondary claims + Attach medical records to claims as needed + Assist management ... 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
- Sanofi Group (Boston, MA)
- … coding , contracting, financial assistance offerings, patient support, access, medical policy and other business-related issues Neurology. In addition, they will ... patient pull though efforts. We are an innovative global healthcare company, committed to transforming the lives of people...it relates to buy & bill processes, billing and coding education, claims and adjudication by site… more
- 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
- Making Opportunity Count Inc (Fitchburg, MA)
- …operations for Reproductive Health and Behavioral Health services, ensuring accurate coding , claims submission, and reimbursement. + Ensure compliance with ... Status: Non-Exempt Union Status: None Job Level: 40 Department: Healthcare Pay Range: $30.24 to $40.91 per hour Reports...Conduct regular audits to ensure accuracy in billing and coding procedures. + Stay up to date with changes… more
- LogixHealth (Bedford, MA)
- …degree or equivalent combination of education and experience. + Overall experience in healthcare operations, medical billing and coding + Good communication ... 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
- Highmark Health (Boston, MA)
- …through analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality ... identified opportunities. This position will necessitate clinical informatics and medical knowledge. **ESSENTIAL RESPONSIBILITIES** + Leads the design, development,… more
- LogixHealth (Bedford, MA)
- …revenue cycle management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting ... of education and experience require + Five years related experience in the healthcare industry in a client facing role required + Intermediate to advanced Excel… more