- 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
- 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
- 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
- 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
- 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
- Fallon Health (Worcester, MA)
- …from medical records. Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations Interface with other ... to this work is a plus, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or other coding certifications or similar in the… more
- 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
- 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
- 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 ... 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
- Elevance Health (Manchester, NH)
- …the team this role will be leading include but are not limited to: claim coding and billing, medical terminology, claims payment and recovery process, system ... operations of a datamining team focused on identifying and recovering overpaid medical claims and maintaining and strengthening the relationship with datamining… 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
- Elevance Health (Woburn, MA)
- …on task forces and committees. **Minimum Requirements:** Requires either a BA/BS degree, medical coding certification and a minimum of 2 years' relevant work ... + Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… 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 ... site, and aliment information for MVA, WC, MD, insurances + Review claims reports and validations; make all corrections to insurance, patient registrations +… more
- CVS Health (Woonsocket, RI)
- …needs and requirements to internal CVS Health teams such as Benefits Coding and Quality Analysis + Facilitating internal and external meetings and presentations ... well as working towards reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization… more