- 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 (Providence, RI)
- …part of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records ... ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied...Home Health, and minor procedures + Experience with the Claims Life Cycle + Experience with coding /auditing… more
- Humana (Providence, RI)
- …**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 (Providence, RI)
- …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
- 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 (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …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
- Family Service Association - Fall River (Fall River, MA)
- …requires a detail-oriented, analytical professional with a strong understanding of healthcare billing, coding , and revenue cycle management + Proficient ... payment receipt. Key responsibilities include reviewing and processing insurance claims , verifying patient insurance information, resolving billing issues, managing… more
- CVS Health (Providence, 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
- CVS Health (Providence, RI)
- …R, Python, or SAS). + At least 2 years of experience analyzing healthcare claims databases. + Healthcare coding expertise (ICD, CPT, HCPCS, GPI). + ... across teams. Strong data analysis skills and experience with healthcare claims databases are essential, along with...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- Cardinal Health (Providence, RI)
- …+ 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
- Prime Therapeutics (Providence, RI)
- …such as GitHub + Prior PBM experience or experience working with medical claims , pharmacy claims , and/or healthcare data + Experience in the ... **Responsibilities** + Under general supervision, analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize analytics to… more
- Humana (Providence, RI)
- …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
- Cardinal Health (Providence, RI)
- …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
- Tufts Medicine (Boston, MA)
- …duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted ... claims , and performs appeals for non-clinical denials, etc. An...2. Two (2) years of experience in an automated medical billing and collection environment for a medical… more
- CVS Health (Providence, RI)
- …the area of healthcare fraud and abuse matters. + Working knowledge of medical coding ; CPT, HCPCS, ICD10 + Proficiency in Microsoft Office with advanced ... level, complex investigations of known or suspected acts of healthcare fraud and abuse. + Routinely handles cases that...fraud schemes. + Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business +… more
- Mathematica (Providence, RI)
- …commercial, Medicare, Medicaid, or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding ). * Ability to describe difficult ... data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and… more