- 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
- 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
- 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
- Humana (Boston, MA)
- …studies and the strategic interpretation of data, the mission of Humana Healthcare Research (HHR) is to produce high-quality, actionable evidence and rigorous, ... community and society at large. HHR maintains external partnerships with healthcare industry, government, academia and others to produce research important to… 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
- 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
- Conviva (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
- 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
- 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
- Cardinal Health (Boston, MA)
- …+ Clear knowledge of Medicare (A, B, C, D) + 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience is preferred + 1-2 years ... additionally follow up if requested to do so. + Responsible for addressing Medical Information inquiries from consumers, healthcare providers and other entities,… more
- Cardinal Health (Boston, MA)
- …of healthcare data, including clinical data, patient demographics, and claims data. Understanding of HIPAA and other relevant regulations, preferred. + Cloud ... Center of Excellence (AI CoE), we are pushing the boundaries of healthcare with cutting-edge Data Science and Artificial Intelligence (AI). Our mission is… more
- Humana (Boston, MA)
- …lines of business, and various domains across Insurance like Enrollment, Product, Claims , Provider, Clinical and Customer Service, etc., to set the future direction, ... and best practices. + Well versed and proficient with coding practices overall and in several programming languages such...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare ? Bring your true colors to blue. This position is eligible for the following persona(s): eWorker, Mobile, & Resident Internship ... lines of business. + Determine the magnitude and drivers of behavioral health claims in light of COVID-19 and increased telehealth usage. + Explore patterns in… more
- Prime Therapeutics (Boston, MA)
- …Management) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical , and/or financial data + Basic to intermediate SAS ... in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare , financial services or related field + Must be...coding skills + Previous experience in a client facing… more