- 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
- 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
- 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
- Insight Global (Woonsocket, RI)
- …and data visualization in Excel, Tableau, Alteryx, Power BI, etc Strong knowledge of medical coding terminology (ie- CPT, CPTII, Loinc Codes, Snomed, ICD10, etc ... a customer facing role providing consultative support 5+ years working with healthcare data ( claims , Medicaid, Medicare, pharmacy, provider, membership, lab/test… more
- Humana (Boston, MA)
- …+ BS in healthcare or business-related field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + Metavance and CAS ... What it takes to Succeed** + 2 years of coding certification or equivalent (Industry-recognized coding certification...from PHIA, AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement… more
- Brown University (Providence, RI)
- …to learn about the United States Health Care System, including standard healthcare coding systems such as International Classification of Diseases versions ... data. + Some experience analyzing and managing large complex data sets, specifically healthcare claims or electronic health record datasets. + Some prior… 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
- 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
- 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
- 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
- CVS Health (Boston, MA)
- …solutions. **Required Qualifications** -6+ Months Working experience reading and understanding claims . -Working knowledge of reading and reviewing claim and ... coding types. -6+ Months Excel. -6+ Months QNXT. -Excellent...databases as well interpretation and manipulation of related data. - Healthcare background. -3-5+ years of data interpretation and analysis… more