- Commonwealth Care Alliance (Boston, MA)
- …TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more
- Prime Therapeutics (Boston, MA)
- …passion and drives every decision we make. **Job Posting Title** Compliance Analyst Sr--Medical Pharmacy Specialty- REMOTE **Job Description** The Senior Compliance ... Analyst assists in the implementation of Prime's compliance programs...to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory… more
- Prime Therapeutics (Boston, MA)
- …drives every decision we make. **Job Posting Title** Compliance Analyst Principal--Medical Pharmacy Specialty- REMOTE **Job Description** The Compliance Principal ... as assigned **Education & Experience** + Bachelor's degree in business , healthcare, or related area of study, or equivalent...or within a highly regulated industry, including experience with Medicare , Advantage and Medicare Part B +… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Senior Actuarial Analyst will support the financial Forecasting and Pricing needs ... annual reporting. This role will also work with various business partners outside of Actuarial in the annual financial...implementing, and presenting findings. Projects are focused on the Medicare Preferred population and support the goal… more
- Harvard University (Cambridge, MA)
- …I Department Office Location:USA - MA - Boston Business Title:Statistical Analyst /ProgrammerSub-Unit: Salary Grade (https://hr.harvard.edu/salary-ranges#ranges) ... and health services research projects. Our research team uses Medicare and other large national claims datasets to evaluate...of accrued vacation time per year (3 weeks for support staff and 4 weeks for administrative/professional staff), 12… more
- Beth Israel Lahey Health (Charlestown, MA)
- …in people's lives.** Reporting to the Manager, Patient Financial Services, the Clinical Analyst plays an important role in a high-profile team tasked with handling ... all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high level clinical appeal for services in the inpatient and… more
- Prime Therapeutics (Boston, MA)
- …and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst (Regulatory Intelligence and Assessment) - Remote **Job Description** The Senior ... Compliance Analyst assists in the implementation of Prime's compliance programs...organization to validate regulatory requirements are met and that business operations are aligned with expectations of applicable regulatory… more
- Mathematica (Boston, MA)
- … sales leadership with planning travel, conference logistics, and prospecting. * Support the development and maintenance of business development materials (for ... wide-ranging areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica… more
- Point32Health (Canton, MA)
- …and complex information into key insights. The individual will work effectively across business areas and often lead collaborative projects. They will need to follow ... complex business processes, consider options when problems arise, and identify...what you will be doing** **Data Submission Integrity** + Support the director across a range of activities, including… more
- HealthEdge Software Inc (Boston, MA)
- …payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration ... capabilities for Commercial lines of business . Payment Integrity Transformation includes rich editing libraries with history-based capabilities, easy development of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …pharmacy benefit interpretation, Medical Policy interpretation, and plan design interpretation. + Support Medicare Part D and understanding of CMS guidelines + ... fax, phone and web. In addition, the Pharmacy Operations Analyst supports inquiries from other business areas...PBM real time on line claims adjudication software. + Support new clinical program implementation + Serve as a… more