- Eisai, Inc (Boston, MA)
- …consists of: NYC, NJ, RI, CT, MA, NH, ME, VT Job Summary The Senior Manager , Access and Reimbursement will appropriately inform, support and manage regional ... (examples: patient assistance, reimbursement support, distribution and coverage policies). The Senior Manager , Access and Reimbursement is a customer-facing… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Under direction of the Director of Medicare Compliance , the primary focus areas of this position include development and ... to regulators + Submit materials to regulators + Coordinate attestations from Senior Leadership for submission ** Compliance Regulatory Guidance Distribution** +… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the creation of controls to manage fraud, waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse ... Prevention (FIP) Unit including management of a team of senior managers, data analysts, fraud investigators, certified coders and...on fraud waste and abuse work, present to the Medicare Compliance Committee and manage requests and… more
- Commonwealth Care Alliance (Boston, MA)
- … (CHC) preferred + 5 or more years direct work experience inregulatory affairs and/or compliance in Medicare or Medicaid required + 5 or more years of managerial ... Role is Important to Us:** Under direction of the Sr . Director of Regulatory & External Audits, the primary...external regulatory agencies including but limited to Centers for Medicare & Medicaid Services (CMS), Mass Health, Departments of… more
- Commonwealth Care Alliance (Boston, MA)
- …Department Regulatory Affairs and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid ... Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an… more
- WellSense (Boston, MA)
- Senior Manager of Clinical UM - BH...Department on issues that have both legal risk and compliance aspects. + Partners with the Accreditation Manager ... that works for our members, no matter their circumstances. **Job Summary:** The Senior Manager of Clinical Utilization Management (UM), Behavioral Health is… more
- Commonwealth Care Alliance (Boston, MA)
- …the direction of the Sr . Director, TPA Management and Claims Compliance , Medical/BH Reimbursement Policy Manager will have overall responsibility for CCA's ... and Behavioral Health reimbursement policies for statewide impact. The Policy Manager is responsible for managing cross-departmental implementation of changes to… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position Overview** **:** As aSenior Manager ,Product ManagementforHealthEdgeSource, you willbededicatedto developing innovative solutions for the ... payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration… more
- Beth Israel Lahey Health (Boston, MA)
- …with any changes in ICD-10 and CPT-4 coding and remains current with Medicare , federal insurance and third party billing compliance regulations. Works ... codes including the appropriate use of modifiers to ensure compliance for reimbursement. **Job Description:** **Essential Responsibilities:** 1. Coordinates coding… more
- Commonwealth Care Alliance (Boston, MA)
- …Role is Important to Us:** **Position Summary:** Reporting to the Chief Risk, Compliance & Ethics Officer, the Vice President, Chief Privacy & Security Officer ... oversight, auditing, monitoring, and ongoing operation of CCA's privacy and security compliance assuring that it meets all requirements of applicable federal and… more
- Highmark Health (Boston, MA)
- …Uses functional and organizational knowledge to mentor Associate, Intermediate, and Senior Business Systems Analysts, as well as others outside of immediate ... limited to, Scrum Master, Business Technical Analyst, User Interface designer, Capability Manager , or Tester, based upon experience and need. + Provide required… more
- State of Massachusetts (Boston, MA)
- …as well as other state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office of Inspector General. The ... and abuse, including identification and implementation of best practices, reporting compliance , claims data analysis, development of key performance indicators, and… more
